Provider Demographics
NPI:1144371352
Name:KACZMAREK-YOUNG, CHRISTINE (PT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:KACZMAREK-YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12914 FM 1960 RD W STE F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5311
Mailing Address - Country:US
Mailing Address - Phone:832-237-3331
Mailing Address - Fax:832-237-4638
Practice Address - Street 1:255 N EGRET BAY BLVD
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6533
Practice Address - Country:US
Practice Address - Phone:281-525-4344
Practice Address - Fax:281-525-4320
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052KXOtherBCBS GROUP #
TX8T6272Medicare UPIN