Provider Demographics
NPI:1174590517
Name:CULLEN, KATHLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:CULLEN
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 1:9 VALENCIA ISLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-2226
Mailing Address - Country:US
Mailing Address - Phone:973-663-6003
Mailing Address - Fax:973-663-6003
Practice Address - Street 1:38 ELM ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4110
Practice Address - Country:US
Practice Address - Phone:973-539-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00635700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist