Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1208796 | TX |
NPI | 1003101890 |
---|---|
Provider Name | Katherine Ann Hoverstadt |
First Address | Dallas, TX 75284-4249 |
Second Address | Round Rock, TX 78665-1053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2011 |
Last Update Date | 18/07/2011 |