Provider Demographics
NPI:1245365857
Name:STORES, CATHY
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:STORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96555
Mailing Address - Country:US
Mailing Address - Phone:805-355-2353
Mailing Address - Fax:
Practice Address - Street 1:KWAJALEIN HOSPITAL ,OCEAN ROAD
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96555
Practice Address - Country:US
Practice Address - Phone:805-355-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2389225100000X
WAPT00005711225100000X
HI1630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist