Provider Demographics
NPI:1497257729
Name:RAFF, CATHERINE MCNULTY (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MCNULTY
Last Name:RAFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MCNULTY RAFF
Other - Last Name:SOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2041 S PACHECO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5473
Mailing Address - Country:US
Mailing Address - Phone:864-630-3986
Mailing Address - Fax:
Practice Address - Street 1:2041 S PACHECO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5473
Practice Address - Country:US
Practice Address - Phone:864-630-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294543225100000X
NM5271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA294543OtherCA LC