Provider Demographics
NPI:1679995724
Name:JASTRZEMBSKI, KATHLEEN M (PT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:JASTRZEMBSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GENEVA DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5332
Mailing Address - Country:US
Mailing Address - Phone:845-226-6976
Mailing Address - Fax:
Practice Address - Street 1:4 GENEVA DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5332
Practice Address - Country:US
Practice Address - Phone:845-226-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011174-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist