MEDICARE: KATHLEEN MARY URENDA 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	2000881	TX

General Provider Information

NPI Number	:	1669647368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARY URENDA PTA

Provider Business Mailing Address
First Line	:	909 HEMLOCK TRL
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3551
Country	:	US
Telephone Number	:	817-656-1220
Fax Number	:	817-656-1220

Provider Business Practice Location Address
First Line	:	909 HEMLOCK TRL
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3551
Country	:	US
Telephone Number	:	817-656-1220
Fax Number	:	817-656-1220

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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