Provider Demographics
NPI:1124408729
Name:BOERNER, CATHERINE JEAN (MS, AT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JEAN
Last Name:BOERNER
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSCS
Mailing Address - Street 1:614 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1599
Mailing Address - Country:US
Mailing Address - Phone:989-463-7989
Mailing Address - Fax:989-463-7431
Practice Address - Street 1:614 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1599
Practice Address - Country:US
Practice Address - Phone:989-463-7989
Practice Address - Fax:989-463-7431
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010013512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer