Provider Demographics
NPI:1356480164
Name:HOUSTON, CATHERINE BRIDGET (PTAL)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:BRIDGET
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PTAL
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:BRIDGET
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTAL
Mailing Address - Street 1:6301 N WALNUT STREET RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-7635
Mailing Address - Country:US
Mailing Address - Phone:217-487-7183
Mailing Address - Fax:
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-0001
Practice Address - Country:US
Practice Address - Phone:217-788-3300
Practice Address - Fax:217-788-5546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant