Basic Information
| Provider Information | |||||||||
| NPI: | 1376264556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUNGMAN | ||||||||
| FirstName: | KATELYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8627 CINNAMON CREEK DR STE 402 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102533888 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21727 W INTERSTATE 10 STE 110 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782572108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103141402 | ||||||||
| FaxNumber: | 2105301309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2022 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1368042 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.