Basic Information
| Provider Information | |||||||||
| NPI: | 1902397177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONDY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | RRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 424 | ||||||||
| Address2: | |||||||||
| City: | KILMARNOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224820424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044367189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CORPORATE BLVD S | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107016862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142946300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 0117003132 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.