Provider Demographics
NPI:1598066052
Name:PATILLO, CATHERINE JEAN (LMT, NCTMB, CHT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JEAN
Last Name:PATILLO
Suffix:
Gender:F
Credentials:LMT, NCTMB, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 S 570 E
Mailing Address - Street 2:18I
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6539
Mailing Address - Country:US
Mailing Address - Phone:801-864-4545
Mailing Address - Fax:
Practice Address - Street 1:4149 S 570 E
Practice Address - Street 2:18I
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6539
Practice Address - Country:US
Practice Address - Phone:801-864-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372434-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist