Provider Demographics
NPI:1023058393
Name:DEMJANENKO, CATHERINE (PT)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:DEMJANENKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-1203
Mailing Address - Country:US
Mailing Address - Phone:716-778-0999
Mailing Address - Fax:716-778-0998
Practice Address - Street 1:2735 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1203
Practice Address - Country:US
Practice Address - Phone:716-778-0999
Practice Address - Fax:716-778-0998
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013755-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9307986OtherIHA
NY000625730001OtherCOMMUNITY BLUE