Provider Demographics
NPI:1013964006
Name:DOLL, CATHERINE MARY (PT MOMT DMT)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARY
Last Name:DOLL
Suffix:
Gender:F
Credentials:PT MOMT DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11434 MIRO CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3315
Mailing Address - Country:US
Mailing Address - Phone:619-980-6169
Mailing Address - Fax:858-695-2350
Practice Address - Street 1:11434 MIRO CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3315
Practice Address - Country:US
Practice Address - Phone:619-980-6169
Practice Address - Fax:858-695-2350
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16384Medicare ID - Type Unspecified
PP88113Medicare UPIN