Provider Demographics
NPI:1487810776
Name:ST. MARS, KATHERINE O (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:O
Last Name:ST. MARS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1607
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78296-1607
Mailing Address - Country:US
Mailing Address - Phone:210-558-6288
Mailing Address - Fax:210-558-6289
Practice Address - Street 1:10839 QUARRY PARK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-257-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11920122251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487810776Medicaid
VA192946OtherBCBS PHYSICAL THERAPY
VA9408173OtherAETNA
VAP00637367OtherRAILROAD MEDICARE
VAC05954Medicare PIN
VA192946OtherBCBS PHYSICAL THERAPY