Provider Demographics
NPI:1477220325
Name:EMBERSICS, KATHRYN JEANETTE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JEANETTE
Last Name:EMBERSICS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATRYN
Other - Middle Name:JEANETTE
Other - Last Name:DUCHARME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:6767 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6414
Mailing Address - Country:US
Mailing Address - Phone:409-722-1485
Mailing Address - Fax:409-722-1564
Practice Address - Street 1:6767 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6414
Practice Address - Country:US
Practice Address - Phone:409-722-1485
Practice Address - Fax:409-722-1564
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2163731225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant