Provider Demographics
NPI:1104339654
Name:HARRELL, KATELYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 W SLAUGHTER LN STE 475
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6267
Mailing Address - Country:US
Mailing Address - Phone:512-520-4242
Mailing Address - Fax:512-782-0287
Practice Address - Street 1:1807 W SLAUGHTER LN STE 475
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6267
Practice Address - Country:US
Practice Address - Phone:512-520-4242
Practice Address - Fax:512-782-0287
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12986652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic