Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 12880 | WI |
Y | 225100000X | Physical Therapist | 1297769 | TX |
NPI | 1003275561 |
---|---|
Provider Name | Miss Katherine Amanda Rostron |
First Address | Pearland, TX 77584-7881 |
Second Address | Pearland, TX 77584-7881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2016 |
Last Update Date | 27/01/2022 |