Provider Demographics
NPI:1205562618
Name:HEBERT, KATHERINE (LMT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HEBERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:TEKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5190 EARHART CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8204
Mailing Address - Country:US
Mailing Address - Phone:757-450-5702
Mailing Address - Fax:
Practice Address - Street 1:5705 LYNNHAVEN PKWY STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-9157
Practice Address - Country:US
Practice Address - Phone:757-450-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019018363OtherVA NURSING LICENSE