Provider Demographics
NPI:1922730258
Name:RADEMAKER, CATHERINE (PTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:RADEMAKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:WACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7213 PLUMPLEAF ROAD #1015
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613
Mailing Address - Country:US
Mailing Address - Phone:920-659-6073
Mailing Address - Fax:
Practice Address - Street 1:2605 BLUE RIDGE RD STE 230
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6475
Practice Address - Country:US
Practice Address - Phone:919-781-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP011470A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant