Basic Information
Provider Information
NPI: 1003018938
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PANKOWSKI
FirstName: KATHLEEN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2629 LONGWOOD DR
Address2:  
City: WILMINGTON
State: DE
PostalCode: 198103714
CountryCode: US
TelephoneNumber: 3025291998
FaxNumber:  
Practice Location
Address1: 549 BALTIMORE PIKE
Address2:  
City: GLEN MILLS
State: PA
PostalCode: 193421020
CountryCode: US
TelephoneNumber: 6103586005
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XJ1-0001322DEN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000XPT016702PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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