Provider Demographics
NPI:1265690689
Name:CATRAL, JOSE RAYMUNDO SORIO JR (PT)
Entity type:Individual
Prefix:MR
First Name:JOSE RAYMUNDO
Middle Name:SORIO
Last Name:CATRAL
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RAY
Other - Middle Name:SORIO
Other - Last Name:CATRAL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:50920 CHERRY FARM TRL
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8942
Mailing Address - Country:US
Mailing Address - Phone:574-250-0162
Mailing Address - Fax:574-272-7355
Practice Address - Street 1:50920 CHERRY FARM TRL
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8942
Practice Address - Country:US
Practice Address - Phone:574-250-0162
Practice Address - Fax:574-272-7355
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004243A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist