Provider Demographics
NPI:1114479292
Name:MORENO, KATHERINE NICOLE (BS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICOLE
Last Name:MORENO
Suffix:
Gender:F
Credentials:BS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14036 SAYLORS ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75756-6655
Mailing Address - Country:US
Mailing Address - Phone:469-360-3136
Mailing Address - Fax:
Practice Address - Street 1:14036 SAYLORS ST
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75756-6655
Practice Address - Country:US
Practice Address - Phone:469-360-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2000026015390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program