Provider Demographics
NPI:1205330537
Name:MITCHELL-CABALLERO, CATHERINE (PT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MITCHELL-CABALLERO
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 1:13630 58TH ST N STE 103B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3734
Mailing Address - Country:US
Mailing Address - Phone:727-530-1201
Mailing Address - Fax:
Practice Address - Street 1:13630 58TH ST N STE 103B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3734
Practice Address - Country:US
Practice Address - Phone:727-530-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist