Healthcare Provider Details

I. General information

NPI: 1700046026
Provider Name (Legal Business Name): KATHRYN E. PASTEKA MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9102 EMMA ST SUITE B
NEEDVILLE TX
77461-8403
US

IV. Provider business mailing address

6011 BAKER RD
NEEDVILLE TX
77461-8753
US

V. Phone/Fax

Practice location:
  • Phone: 979-531-9598
  • Fax:
Mailing address:
  • Phone: 979-531-9598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT023622
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: