Healthcare Provider Details

I. General information

NPI: 1295737138
Provider Name (Legal Business Name): KATHERINE IRENE DIERINGER ATC, LAT, OPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 SAN JACINTO BLVD SUITE 108
DENTON TX
76205-7535
US

IV. Provider business mailing address

2318 SAN JACINTO BLVD SUITE 108
DENTON TX
76205-7535
US

V. Phone/Fax

Practice location:
  • Phone: 940-380-9111
  • Fax: 940-380-9112
Mailing address:
  • Phone: 940-380-9111
  • Fax: 940-380-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATO789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: