Provider Demographics
NPI:1205585858
Name:TOTA, KATHERINE ANNE (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:TOTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 KING RD APT GREENTREE 111
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1975
Mailing Address - Country:US
Mailing Address - Phone:908-399-0431
Mailing Address - Fax:
Practice Address - Street 1:580 REED RD STE 3
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3655
Practice Address - Country:US
Practice Address - Phone:610-356-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT030321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT030321OtherPENNSYLVANIA STATE BOARD OF PHYSICAL THERAPY
NJ40QA02072900OtherNEW JERSEY STATE BOARD OF PHYSICAL THERAPY