Provider Demographics
NPI:1437369741
Name:RUBIN-CAMPOS, CATHERINE ANN (PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:RUBIN-CAMPOS
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 1:7708 HARBORSIDE DR
Mailing Address - Street 2:APT E
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8271
Mailing Address - Country:US
Mailing Address - Phone:901-550-5770
Mailing Address - Fax:
Practice Address - Street 1:200 MEADOW LAKE DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1837
Practice Address - Country:US
Practice Address - Phone:317-834-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008654A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist