Provider Demographics
NPI:1487845822
Name:PIMENTEL, IVY CATHERINE CABAUATAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:IVY CATHERINE
Middle Name:CABAUATAN
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 VIOLET PL
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4918
Mailing Address - Country:US
Mailing Address - Phone:301-589-7136
Mailing Address - Fax:
Practice Address - Street 1:809 VIOLET PL
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4918
Practice Address - Country:US
Practice Address - Phone:301-589-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist