Provider Demographics
NPI:1851789457
Name:SPEAK, CATHERINE B (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:B
Last Name:SPEAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:B
Other - Last Name:HANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1928 LYNDHURST DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1092
Mailing Address - Country:US
Mailing Address - Phone:703-647-0564
Mailing Address - Fax:
Practice Address - Street 1:12025 SAN JOSE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1639
Practice Address - Country:US
Practice Address - Phone:904-880-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist