Provider Demographics
NPI:1154709012
Name:NAVARRO, KATELYN BRITT (DPT)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:BRITT
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KATELYN
Other - Middle Name:AMBER
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8164 ROSEMARY SAGE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4150
Mailing Address - Country:US
Mailing Address - Phone:318-294-0681
Mailing Address - Fax:
Practice Address - Street 1:8164 ROSEMARY SAGE DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4150
Practice Address - Country:US
Practice Address - Phone:318-294-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1303278225100000X
LA08903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$Medicaid