Provider Demographics
NPI:1770006819
Name:SOUSA, CATHERINE SOPHIA (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SOPHIA
Last Name:SOUSA
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 1:22 LOCHARRON DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-2983
Mailing Address - Country:US
Mailing Address - Phone:301-351-1801
Mailing Address - Fax:
Practice Address - Street 1:910 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3158
Practice Address - Country:US
Practice Address - Phone:302-477-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist