Provider Demographics
NPI:1821180837
Name:MALLOY, CATHERINE V S (PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:V S
Last Name:MALLOY
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 1:1113 S MILWAUKEE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3777
Mailing Address - Country:US
Mailing Address - Phone:847-388-0831
Mailing Address - Fax:
Practice Address - Street 1:1113 S MILWAUKEE AVE STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3777
Practice Address - Country:US
Practice Address - Phone:847-388-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist