MEDICARE: CATHERINE RYANN PHILLIPS PTA

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	225200000X	Physical Therapy Assistant	2139956	TX

General Provider Information

NPI Number	:	1407322761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE RYANN PHILLIPS PTA

Provider Business Mailing Address
First Line	:	2903 ROYAL BAY CT
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2589
Country	:	US
Telephone Number	:	281-910-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	11450 SPACE CENTER BLVD STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3642
Country	:	US
Telephone Number	:	281-998-0901
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	10/15/2018

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