Provider Demographics
NPI:1114229648
Name:RADGOWSKI, CATHERYNE MAE (MSPT)
Entity type:Individual
Prefix:
First Name:CATHERYNE
Middle Name:MAE
Last Name:RADGOWSKI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CATHERYNE
Other - Middle Name:MAE
Other - Last Name:CHAPIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2475 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6332
Mailing Address - Country:US
Mailing Address - Phone:405-447-1991
Mailing Address - Fax:405-447-1198
Practice Address - Street 1:2475 BOARDWALK
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6332
Practice Address - Country:US
Practice Address - Phone:405-447-1991
Practice Address - Fax:405-447-1198
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200000920AMedicaid
OKOKAAA2687Medicare UPIN