Provider Demographics
NPI:1235477142
Name:HOSEK, KATELYN MARIE
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:HOSEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14069 US HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79084-3825
Mailing Address - Country:US
Mailing Address - Phone:303-906-4498
Mailing Address - Fax:
Practice Address - Street 1:115 E TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4319
Practice Address - Country:US
Practice Address - Phone:806-244-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2094230225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant