Provider Demographics
NPI:1174671697
Name:KADLECEK, CHRIS PHILIP (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:PHILIP
Last Name:KADLECEK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 STAGECOACH RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2322
Mailing Address - Country:US
Mailing Address - Phone:512-264-1409
Mailing Address - Fax:
Practice Address - Street 1:810 W BRAKER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4111
Practice Address - Country:US
Practice Address - Phone:512-836-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist