Provider Demographics
NPI:1760555650
Name:EUSTAQUIO, KATHERINE (PTA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:EUSTAQUIO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13089 PEYTON DR # C134
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6018
Mailing Address - Country:US
Mailing Address - Phone:909-973-2546
Mailing Address - Fax:
Practice Address - Street 1:17487 HURLEY ST
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91744-5106
Practice Address - Country:US
Practice Address - Phone:626-935-7723
Practice Address - Fax:626-912-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4910225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant