Provider Demographics
NPI:1164572152
Name:DEVINE, KATHLEEN LEGER (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LEGER
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:LEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1509 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-8132
Mailing Address - Country:US
Mailing Address - Phone:940-387-7974
Mailing Address - Fax:
Practice Address - Street 1:725 I-35E SOUTH
Practice Address - Street 2:SUITE 152
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205
Practice Address - Country:US
Practice Address - Phone:940-565-8402
Practice Address - Fax:940-565-8304
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist