Provider Demographics
NPI:1235296849
Name:GEPHART, CATHLEEN MARIE (PT, OCS)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MARIE
Last Name:GEPHART
Suffix:
Gender:F
Credentials:PT, OCS
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2005 IRONWOOD PKWY
Mailing Address - Street 2:STE 224
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2647
Mailing Address - Country:US
Mailing Address - Phone:208-665-2468
Mailing Address - Fax:208-665-2468
Practice Address - Street 1:2005 IRONWOOD PKWY
Practice Address - Street 2:STE 224
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2647
Practice Address - Country:US
Practice Address - Phone:208-661-7167
Practice Address - Fax:208-665-2468
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPT-7982251X0800X
WAPT000059522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID203478704OtherEIN #