Provider Demographics
NPI:1558376285
Name:KATCHUK, HOLLY SUE (DPT)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:SUE
Last Name:KATCHUK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901
Mailing Address - Country:US
Mailing Address - Phone:304-645-2525
Mailing Address - Fax:304-645-2820
Practice Address - Street 1:717 N JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901
Practice Address - Country:US
Practice Address - Phone:304-645-2525
Practice Address - Fax:304-645-2525
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001712692OtherMOUNTAIN STATE BLUE CROSS
WV3910001442Medicaid
WV3910001442Medicaid
Q31771Medicare UPIN