Provider Demographics
NPI:1205193992
Name:ABBOTT, CATHY (MT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 W SPRUCE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3576
Mailing Address - Country:US
Mailing Address - Phone:559-977-2077
Mailing Address - Fax:
Practice Address - Street 1:4733 W SPRUCE AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3576
Practice Address - Country:US
Practice Address - Phone:559-977-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist