Provider Demographics
NPI:1164570263
Name:SUPAK, CATHY POERNER (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:POERNER
Last Name:SUPAK
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14714 GRAYWOOD GROVE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2108
Mailing Address - Country:US
Mailing Address - Phone:281-480-1417
Mailing Address - Fax:281-333-8875
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:281-333-8806
Practice Address - Fax:281-333-8875
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT-07972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer