Provider Demographics
NPI:1518522861
Name:KATZBERG, CATHERINE M (LMT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:KATZBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:M
Other - Last Name:KATZBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:11 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910
Mailing Address - Country:US
Mailing Address - Phone:401-580-4754
Mailing Address - Fax:
Practice Address - Street 1:SANTOSHA YOGA STUDIO
Practice Address - Street 2:275 RESERVOIR AVE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907
Practice Address - Country:US
Practice Address - Phone:401-780-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT00121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty