Provider Demographics
NPI:1184256059
Name:GONDEK, KASIA (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:KASIA
Middle Name:
Last Name:GONDEK
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 E ORANGE GROVE BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4600
Mailing Address - Country:US
Mailing Address - Phone:818-665-5534
Mailing Address - Fax:
Practice Address - Street 1:3702 PARK PL
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1623
Practice Address - Country:US
Practice Address - Phone:818-864-6732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist