Provider Demographics
NPI:1245330547
Name:MEEHAN, CATHERINE A (PT)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:A
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:A
Other - Last Name:FASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1340 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-3434
Mailing Address - Country:US
Mailing Address - Phone:518-761-6580
Mailing Address - Fax:
Practice Address - Street 1:1340 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3434
Practice Address - Country:US
Practice Address - Phone:518-761-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025981-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00752456Medicaid