Provider Demographics
NPI:1952709149
Name:MANTHURUTHIL, KATHERINE LEIGH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEIGH
Last Name:MANTHURUTHIL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEIGH
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1919 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1358
Mailing Address - Country:US
Mailing Address - Phone:219-851-3399
Mailing Address - Fax:
Practice Address - Street 1:1919 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1358
Practice Address - Country:US
Practice Address - Phone:219-851-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-20
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist