Provider Demographics
NPI:1477219491
Name:HERRING, CATELYN NICOLE (PTA)
Entity Type:Individual
Prefix:
First Name:CATELYN
Middle Name:NICOLE
Last Name:HERRING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WOODFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7635
Mailing Address - Country:US
Mailing Address - Phone:478-662-1612
Mailing Address - Fax:
Practice Address - Street 1:4430 WADE GREEN RD NW STE 60
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1267
Practice Address - Country:US
Practice Address - Phone:678-293-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant