Provider Demographics
NPI:1700818333
Name:DUBOIS, CATHERINE A (PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:DUBOIS
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 1:43 SHUFELT RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-3514
Mailing Address - Country:US
Mailing Address - Phone:518-755-3171
Mailing Address - Fax:
Practice Address - Street 1:43 SHUFELT RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-3514
Practice Address - Country:US
Practice Address - Phone:518-755-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5296225100000X
NY007428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00007428Medicaid