Provider Demographics
NPI:1932588126
Name:AGBUYA, MARIE JOCELYN CATOLOS (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE JOCELYN
Middle Name:CATOLOS
Last Name:AGBUYA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1811
Mailing Address - Country:US
Mailing Address - Phone:207-236-4197
Mailing Address - Fax:
Practice Address - Street 1:105 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1811
Practice Address - Country:US
Practice Address - Phone:207-236-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1243028225100000X
MEPT4380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist