Individual
KATHLEEN JOHNSON WESOLOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
450 W STATE ST STE 270, EAGLE, ID 83616-6974
(208) 462-0808
(208) 516-4488
Mailing address
1832 N BELLO SARA WAY, EAGLE, ID 83616-6989
(408) 439-2414
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT15209
CA
2251X0800X
Orthopedic Physical Therapist
PT-9207
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-9207
STATE LICENSE
ID
01
—
PT15209
STATE LICENSE
CA
Enumeration date
07/27/2006
Last updated
07/16/2024
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