Provider Demographics
NPI:1497824080
Name:TARTE, CATHERINE (PT, OCS, CLT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:TARTE
Suffix:
Gender:F
Credentials:PT, OCS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 PENN ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3908
Practice Address - Country:US
Practice Address - Phone:310-426-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66790ZOtherBLUE SHIELD GROUP #
CAZZZ66790ZOtherBLUE SHIELD GROUP #
CAWPT16417CMedicare ID - Type UnspecifiedPERSONAL MEDICARE #