Provider Demographics
NPI:1245342971
Name:MAGDIS, CATHERINE JEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JEAN
Last Name:MAGDIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:JEAN
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:79 FITZGERALD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1708
Mailing Address - Country:US
Mailing Address - Phone:508-248-5468
Mailing Address - Fax:
Practice Address - Street 1:48 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1284
Practice Address - Country:US
Practice Address - Phone:508-347-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist