Healthcare Provider Details

I. General information

NPI: 1376940619
Provider Name (Legal Business Name): CATHERINE MIZE LPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 COIT RD SUITE 102
PLANO TX
75075-7757
US

IV. Provider business mailing address

1220 COIT RD SUITE 102
PLANO TX
75075-7757
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-8344
  • Fax: 972-769-0644
Mailing address:
  • Phone: 972-769-8344
  • Fax: 972-769-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number63
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: