Provider Demographics
NPI:1629555743
Name:ROSS-BREWER, KATARA (LMT)
Entity Type:Individual
Prefix:
First Name:KATARA
Middle Name:
Last Name:ROSS-BREWER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 N CENTRAL EXPY STE 3004
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3447
Mailing Address - Country:US
Mailing Address - Phone:469-754-1232
Mailing Address - Fax:
Practice Address - Street 1:5025 N CENTRAL EXPY STE 3004
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3447
Practice Address - Country:US
Practice Address - Phone:469-754-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT129167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist