Provider Demographics
NPI:1942605910
Name:ZUKOWSKI, CATHERINE M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:M
Last Name:ZUKOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5009 N EXECUTIVE DR STE B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4866
Mailing Address - Country:US
Mailing Address - Phone:309-678-3844
Mailing Address - Fax:
Practice Address - Street 1:5009 N EXECUTIVE DR STE B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4866
Practice Address - Country:US
Practice Address - Phone:309-678-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227007240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist