Provider Demographics
NPI:1710432513
Name:CERDA, CATHY VENEGAS
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:VENEGAS
Last Name:CERDA
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 1:7824 LANDERS LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-9007
Mailing Address - Country:US
Mailing Address - Phone:214-587-4994
Mailing Address - Fax:
Practice Address - Street 1:7824 LANDERS LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-9007
Practice Address - Country:US
Practice Address - Phone:214-587-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1281032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158966501Medicaid