Provider Demographics
NPI:1164596748
Name:CAMACHO, KATHRYN CHERYL (RPT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:CHERYL
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NORTH TRAVIS
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4554
Mailing Address - Country:US
Mailing Address - Phone:281-592-2884
Mailing Address - Fax:281-592-3269
Practice Address - Street 1:102 NORTH TRAVIS
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4554
Practice Address - Country:US
Practice Address - Phone:281-592-2884
Practice Address - Fax:281-592-3269
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6163225100000X
TX1177058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist