Provider Demographics
NPI:1497089577
Name:CATTANEO, MARY KAY (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:CATTANEO
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 1:2250 REED STATION PKWY, STE. 305
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901
Mailing Address - Country:US
Mailing Address - Phone:618-529-1943
Mailing Address - Fax:618-549-2975
Practice Address - Street 1:2250 REED STATION PKWY, STE. 305
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-529-1943
Practice Address - Fax:618-549-2975
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00900438OtherRR MC
A03331OtherHL
ILP00900438OtherRR MC