Healthcare Provider Details

I. General information

NPI: 1669647368
Provider Name (Legal Business Name): KATHLEEN MARY URENDA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HEMLOCK TRL
SAGINAW TX
76131-3551
US

IV. Provider business mailing address

909 HEMLOCK TRL
SAGINAW TX
76131-3551
US

V. Phone/Fax

Practice location:
  • Phone: 817-656-1220
  • Fax: 817-656-1220
Mailing address:
  • Phone: 817-656-1220
  • Fax: 817-656-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2000881
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: