Provider Demographics
NPI:1972744324
Name:ELLIS, CATHERINE CAMBIA (ATC)
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:CAMBIA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2018
Mailing Address - Country:US
Mailing Address - Phone:270-293-0587
Mailing Address - Fax:270-809-5526
Practice Address - Street 1:217 STEWART STADIUM
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-3351
Practice Address - Country:US
Practice Address - Phone:270-809-5580
Practice Address - Fax:270-809-5526
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT6282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer