Provider Demographics
NPI:1518146208
Name:KAGELER, KATHLEEN MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MICHELLE
Last Name:KAGELER
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 1:301 TROPHY LAKE DR
Mailing Address - Street 2:SUITE 152
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5238
Mailing Address - Country:US
Mailing Address - Phone:817-491-4775
Mailing Address - Fax:817-491-4889
Practice Address - Street 1:301 TROPHY LAKE DR
Practice Address - Street 2:SUITE 152
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5238
Practice Address - Country:US
Practice Address - Phone:817-491-4775
Practice Address - Fax:817-491-4889
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist