Provider Demographics
NPI:1831969880
Name:SOUTH TEXAS PELVIC HEALTH
Entity type:Organization
Organization Name:SOUTH TEXAS PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PCES
Authorized Official - Phone:361-317-1530
Mailing Address - Street 1:245 MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-1720
Mailing Address - Country:US
Mailing Address - Phone:361-317-1530
Mailing Address - Fax:361-264-1862
Practice Address - Street 1:1045 AIRLINE RD # 1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3406
Practice Address - Country:US
Practice Address - Phone:361-317-1530
Practice Address - Fax:361-264-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty