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NPI Code Detail

MEDICARE: KATHERINE LEIGH MANTHURUTHIL PT, DPT

MEDICARE: KATHERINE LEIGH MANTHURUTHIL PT, DPT
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
1225100000XPhysical Therapist1221617TX

General Provider Information

NPI Number : 1952709149
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE LEIGH MANTHURUTHIL PT, DPT
Provider Business Mailing Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 219-851-3399
Fax Number :
Provider Business Practice Location Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 219-851-3399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2014
Last Update Date : 12/20/2014

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