Healthcare Provider Details

I. General information

NPI: 1962705921
Provider Name (Legal Business Name): KATIE ROSE CALDWELL LICENSED MASSAGE THE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7670 PLAINVIEW ROAD
KRUM TX
76249
US

IV. Provider business mailing address

2212 DENISON ST
DENTON TX
76201-1857
US

V. Phone/Fax

Practice location:
  • Phone: 940-566-1880
  • Fax:
Mailing address:
  • Phone: 940-735-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: