Provider Demographics
NPI:1467078618
Name:CLEGHORN, KHADIJA NATASHA SIMONE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KHADIJA
Middle Name:NATASHA SIMONE
Last Name:CLEGHORN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373 N SAM HOUSTON PKWY E APT 327
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4430
Mailing Address - Country:US
Mailing Address - Phone:954-899-4495
Mailing Address - Fax:
Practice Address - Street 1:19002 MCKAY DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5701
Practice Address - Country:US
Practice Address - Phone:281-446-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016957225100000X
TX1318870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1318870OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
COPTL.0016957OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES