Provider Demographics
NPI:1124380522
Name:KATIE'S PEDIATRIC THERAPY SERVICE
Entity Type:Organization
Organization Name:KATIE'S PEDIATRIC THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-203-1833
Mailing Address - Street 1:920 N. AVE I
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-5296
Mailing Address - Country:US
Mailing Address - Phone:830-203-1833
Mailing Address - Fax:361-594-8818
Practice Address - Street 1:920 N. AVE I
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-5296
Practice Address - Country:US
Practice Address - Phone:830-203-1833
Practice Address - Fax:361-594-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131175225100000X
TX108548225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212178201Medicaid