Provider Demographics
NPI:1275966343
Name:FAZIO, KATHRYN (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FAZIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11471 E LOOP 1604 N STE 101
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3960
Mailing Address - Country:US
Mailing Address - Phone:210-428-7845
Mailing Address - Fax:210-741-7699
Practice Address - Street 1:11471 E LOOP 1604 N STE 101
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3960
Practice Address - Country:US
Practice Address - Phone:210-428-7845
Practice Address - Fax:210-741-7699
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist