Provider Demographics
NPI:1205220092
Name:SMOCK, CATE
Entity Type:Individual
Prefix:
First Name:CATE
Middle Name:
Last Name:SMOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-0932
Mailing Address - Country:US
Mailing Address - Phone:970-903-9492
Mailing Address - Fax:
Practice Address - Street 1:1309 E 3RD AVE
Practice Address - Street 2:104
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5255
Practice Address - Country:US
Practice Address - Phone:970-903-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist