Provider Demographics
NPI:1861788671
Name:ROONEY, KATHLEEN (ATC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ROONEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MINEOLA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3920
Mailing Address - Country:US
Mailing Address - Phone:516-741-3338
Mailing Address - Fax:
Practice Address - Street 1:155 MINEOLA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3920
Practice Address - Country:US
Practice Address - Phone:516-741-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002047-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer