Individual
KATHRYN DEBACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
A.S., LCMT
Contact information
Practice address
1424 MORRISON AVE, STOCKTON, CA 95205-3538
(209) 430-1461
Mailing address
PO BOX 1841, STOCKTON, CA 95201-1841
(209) 430-1461
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
66723
CA
225400000X
Rehabilitation Practitioner
66723
CA
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
66723
CA
225700000X
Massage Therapist
Primary
60873
CA
Other
Enumeration date
12/22/2014
Last updated
04/19/2016
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