Provider Demographics
NPI:1750884482
Name:FISK, CATHREINE RENEE (LMT)
Entity type:Individual
Prefix:
First Name:CATHREINE
Middle Name:RENEE
Last Name:FISK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WESTPORT RD STE A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:270-769-2205
Practice Address - Street 1:620 WESTPORT RD STE A
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4408
Practice Address - Country:US
Practice Address - Phone:502-791-6486
Practice Address - Fax:270-769-2205
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty