Provider Demographics
NPI:1013054493
Name:CATLIN-EVANS, MARISSA (MPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CATLIN-EVANS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:CATLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-1099
Mailing Address - Country:US
Mailing Address - Phone:352-475-3113
Mailing Address - Fax:352-475-5796
Practice Address - Street 1:7237 STRICKLIN LN
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-8570
Practice Address - Country:US
Practice Address - Phone:352-359-2299
Practice Address - Fax:352-475-5796
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013054493Medicaid
OR500632985Medicaid