Provider Demographics
NPI:1962705921
Name:CALDWELL, KATIE ROSE (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ROSE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 DENISON ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1857
Mailing Address - Country:US
Mailing Address - Phone:940-735-5702
Mailing Address - Fax:
Practice Address - Street 1:7670 PLAINVIEW ROAD
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249
Practice Address - Country:US
Practice Address - Phone:940-566-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist