Provider Demographics
NPI:1407322761
Name:PHILLIPS, CATHERINE RYANN (PTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RYANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 ROYAL BAY CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2589
Mailing Address - Country:US
Mailing Address - Phone:281-910-1252
Mailing Address - Fax:
Practice Address - Street 1:11450 SPACE CENTER BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3642
Practice Address - Country:US
Practice Address - Phone:281-998-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2139956225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant