Provider Demographics
NPI:1033364732
Name:KHO, KATHRYN TAN (PT)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:TAN
Last Name:KHO
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 1:333 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2719
Mailing Address - Country:US
Mailing Address - Phone:646-327-0453
Mailing Address - Fax:
Practice Address - Street 1:333 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2719
Practice Address - Country:US
Practice Address - Phone:646-327-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist