Provider Demographics
NPI:1659580892
Name:BLATCHLY, CATHLEEN (PT)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:
Last Name:BLATCHLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 PEARL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2780
Mailing Address - Country:US
Mailing Address - Phone:419-352-0172
Mailing Address - Fax:
Practice Address - Street 1:536 PEARL ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2780
Practice Address - Country:US
Practice Address - Phone:419-352-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT4067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208864Medicaid
OH366706Medicare ID - Type Unspecified