Provider Demographics
NPI:1306567045
Name:VILLALOBOS, KATHRYN ELEXIS (PTA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELEXIS
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 S EGRET BAY BLVD APT 450
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5704
Mailing Address - Country:US
Mailing Address - Phone:361-696-9010
Mailing Address - Fax:
Practice Address - Street 1:1445 S EGRET BAY BLVD APT 450
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5704
Practice Address - Country:US
Practice Address - Phone:361-696-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2153818225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant