Provider Demographics
NPI:1104905553
Name:THOSATH, CATHY L (DPM)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:THOSATH
Suffix:
Gender:F
Credentials:DPM
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 1786
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-1786
Mailing Address - Country:US
Mailing Address - Phone:425-788-1484
Mailing Address - Fax:425-788-2024
Practice Address - Street 1:19309 218TH PL NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077-7112
Practice Address - Country:US
Practice Address - Phone:425-788-1484
Practice Address - Fax:425-788-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000410213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7083165Medicaid
WAU24123Medicare UPIN
WA7083165Medicaid