Provider Demographics
NPI:1174037964
Name:STONE, KATELYN SUZANNE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:SUZANNE
Last Name:STONE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10666 KOSUB LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-9808
Mailing Address - Country:US
Mailing Address - Phone:361-533-6125
Mailing Address - Fax:
Practice Address - Street 1:7173 FM 1628
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78263-9671
Practice Address - Country:US
Practice Address - Phone:210-649-2951
Practice Address - Fax:210-581-1357
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT52642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty