Provider Demographics
NPI:1336389436
Name:DEBOSE, KATHY (LMT)
Entity Type:Individual
Prefix:PROF
First Name:KATHY
Middle Name:
Last Name:DEBOSE
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 1:22221 MOSS FALLS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8725
Mailing Address - Country:US
Mailing Address - Phone:832-438-9665
Mailing Address - Fax:
Practice Address - Street 1:22221 MOSS FALLS LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-8725
Practice Address - Country:US
Practice Address - Phone:832-438-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103413172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103413OtherMECHANO THERAPIST