Provider Demographics
NPI:1720627953
Name:YEAGER, CATHERINE LOUISE (LMT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LOUISE
Last Name:YEAGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:LOUISE
Other - Last Name:MCQUAID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:246 BEACH 126TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1721
Mailing Address - Country:US
Mailing Address - Phone:917-821-3555
Mailing Address - Fax:
Practice Address - Street 1:246 BEACH 126TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1721
Practice Address - Country:US
Practice Address - Phone:917-821-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023013225200000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant