Provider Demographics
NPI:1164431912
Name:FLAGGE, KATHLEEN F (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:F
Last Name:FLAGGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 COLLEGE PARK DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4000
Mailing Address - Country:US
Mailing Address - Phone:936-273-1095
Mailing Address - Fax:936-273-1074
Practice Address - Street 1:1501 RIVER POINTE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2656
Practice Address - Country:US
Practice Address - Phone:936-756-0086
Practice Address - Fax:936-756-0085
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1043586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2665OtherBLUE CROSS BLUE SHIELD
TX8T2665OtherBLUE CROSS BLUE SHIELD