MEDICARE: KATELYN FANDRICH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1407515	TX

General Provider Information

NPI Number	:	1013881960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN FANDRICH

Provider Business Mailing Address
First Line	:	3569 E GLEN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-1030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20465 GULF VICTORY WAY
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79918-8066
Country	:	US
Telephone Number	:	864-404-1196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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Directions to “ KATELYN FANDRICH ” Practice Location

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