Provider Demographics
NPI:1124279724
Name:FREITAS, CATHY LYNN (LMT)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:LYNN
Last Name:FREITAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MASSAGE
Other - Middle Name:FROM
Other - Last Name:THE HEART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-0655
Mailing Address - Country:US
Mailing Address - Phone:541-761-0032
Mailing Address - Fax:
Practice Address - Street 1:510 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9615
Practice Address - Country:US
Practice Address - Phone:541-761-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist