Provider Demographics
NPI:1124527890
Name:ANDRES, KATHRYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:ANDRES
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 1:28552 STATE ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:IN
Mailing Address - Zip Code:47060-8734
Mailing Address - Country:US
Mailing Address - Phone:513-673-5729
Mailing Address - Fax:
Practice Address - Street 1:3001 FM 2181 STE 150
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-0109
Practice Address - Country:US
Practice Address - Phone:940-498-4004
Practice Address - Fax:940-498-4008
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017269225100000X
TX1313797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT017269OtherPT LICENSE