Healthcare Provider Details

I. General information

NPI: 1336389436
Provider Name (Legal Business Name): KATHY DEBOSE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22221 MOSS FALLS LN
SPRING TX
77373-8725
US

IV. Provider business mailing address

22221 MOSS FALLS LN
SPRING TX
77373-8725
US

V. Phone/Fax

Practice location:
  • Phone: 832-438-9665
  • Fax:
Mailing address:
  • Phone: 832-438-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number103413
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: