Provider Demographics
NPI:1194029363
Name:RICHBURG, KATHY L (LMTCMMP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:L
Last Name:RICHBURG
Suffix:
Gender:F
Credentials:LMTCMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-1902
Mailing Address - Country:US
Mailing Address - Phone:972-805-7061
Mailing Address - Fax:
Practice Address - Street 1:10203 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3401
Practice Address - Country:US
Practice Address - Phone:214-890-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008113225700000X
226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist