Basic Information
| Provider Information | |||||||||
| NPI: | 1225176845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVEREAUX' | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4653 N SAN ANDROS | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334115574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614220783 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3898 VIA POINCIANA | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334672951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619669273 | ||||||||
| FaxNumber: | 5619668810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2007 | ||||||||
| LastUpdateDate: | 08/21/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1160400 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 23500 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.