Provider Demographics
NPI:1932869369
Name:SHOUP, KATIE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:SHOUP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 MONTANA AVE STE H
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2143
Mailing Address - Country:US
Mailing Address - Phone:915-838-7604
Mailing Address - Fax:866-218-8230
Practice Address - Street 1:6601 MONTANA AVE STE H
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2143
Practice Address - Country:US
Practice Address - Phone:915-838-7604
Practice Address - Fax:866-218-8230
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1355236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist