Provider Demographics
NPI:1396866067
Name:WYCOFF, CATHERINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:WYCOFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39149 FRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:LOVETTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20180-2749
Mailing Address - Country:US
Mailing Address - Phone:703-994-4834
Mailing Address - Fax:703-649-6049
Practice Address - Street 1:39149 FRY FARM RD
Practice Address - Street 2:
Practice Address - City:LOVETTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20180
Practice Address - Country:US
Practice Address - Phone:703-994-4834
Practice Address - Fax:703-649-6049
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2391225100000X
VA2305204182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA150858Medicare PIN