Provider Demographics
NPI:1043467822
Name:KATZ, JACQUELINE (MSPT,JD)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:MSPT,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 LISBON RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1415
Mailing Address - Country:US
Mailing Address - Phone:207-784-3400
Mailing Address - Fax:207-784-6400
Practice Address - Street 1:1977 LISBON RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1415
Practice Address - Country:US
Practice Address - Phone:207-784-3400
Practice Address - Fax:207-784-6400
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist