Healthcare Provider Details

I. General information

NPI: 1194064204
Provider Name (Legal Business Name): KATIE MARTIN DOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 TOEPPERWEIN RD STE 104
LIVE OAK TX
78233-3266
US

IV. Provider business mailing address

12702 TOEPPERWEIN RD STE 104
LIVE OAK TX
78233-3266
US

V. Phone/Fax

Practice location:
  • Phone: 210-653-4420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1227505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: