Provider Demographics
NPI:1104888346
Name:MORMILE, CATHERINE S (DPT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:S
Last Name:MORMILE
Suffix:
Gender:F
Credentials:DPT
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 3566
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-355-3515
Mailing Address - Fax:907-745-7269
Practice Address - Street 1:3003 MINNESOTA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-355-3515
Practice Address - Fax:907-745-7269
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK313225100000X
AK354225X00000X
AKPSYO354225XP0019X
AKPSYP3132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT0313Medicaid
209367OtherPHP GENERIC ID
AK75-1754187OtherTAX ID
AKK0000WCKJTOtherMEDICARE GROUP