Provider Demographics
NPI:1750454617
Name:CAHILL, CATHERINE M (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:CAHILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10539 LAURISTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2314
Mailing Address - Country:US
Mailing Address - Phone:310-490-4430
Mailing Address - Fax:
Practice Address - Street 1:11740 SAN VICENTE BLVD
Practice Address - Street 2:#205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6610
Practice Address - Country:US
Practice Address - Phone:310-820-7602
Practice Address - Fax:310-820-7818
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT15814OtherPHYSICAL THERAPY LICENSE