Provider Demographics
NPI:1487278032
Name:SHEEHAN, KATHERINE IRENE (PTA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IRENE
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SUNNY SLOPES RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:TOMS PLACE
Mailing Address - State:CA
Mailing Address - Zip Code:93546-6371
Mailing Address - Country:US
Mailing Address - Phone:510-390-5355
Mailing Address - Fax:
Practice Address - Street 1:162 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3415
Practice Address - Country:US
Practice Address - Phone:760-872-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47925225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47925OtherPHYSICAL THERAPY BOARD OF CA