Provider Demographics
NPI:1669687604
Name:WEED, CATHY JO
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:JO
Last Name:WEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-9644
Mailing Address - Country:US
Mailing Address - Phone:209-358-5483
Mailing Address - Fax:
Practice Address - Street 1:2808 PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3375
Practice Address - Country:US
Practice Address - Phone:209-723-8144
Practice Address - Fax:209-723-5605
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist