Provider Demographics
NPI:1811181720
Name:TATUM, KATHY JEAN (PTA)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JEAN
Last Name:TATUM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 EARL DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7018
Mailing Address - Country:US
Mailing Address - Phone:830-329-4751
Mailing Address - Fax:
Practice Address - Street 1:413 EARL DRIVE
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-7018
Practice Address - Country:US
Practice Address - Phone:830-329-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02122009225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant