Provider Demographics
NPI:1255319539
Name:YOCUM, CATHERINE MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARY
Last Name:YOCUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:MARY
Other - Last Name:PROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:3218 DAUGHERTY DR
Practice Address - Street 2:SUITE #160
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-3997
Practice Address - Country:US
Practice Address - Phone:317-390-5575
Practice Address - Fax:317-486-2189
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001778A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200113890BMedicaid
IN650024769OtherRAILROAD MEDICARE
IN11356OtherARNETT HEALTH PLANS
IN200113890BMedicaid
IN185450Medicare ID - Type Unspecified