Provider Demographics
NPI:1619909835
Name:MARTIN, CATHERINE ANN (PT)
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:441 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3627
Mailing Address - Country:US
Mailing Address - Phone:337-457-8164
Mailing Address - Fax:337-546-6515
Practice Address - Street 1:441 MOOSA BLVD
Practice Address - Street 2:REHAB XCEL OF EUNICE LLC
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3627
Practice Address - Country:US
Practice Address - Phone:337-457-8164
Practice Address - Fax:337-546-6515
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H827C892Medicare ID - Type Unspecified