Provider Demographics
NPI:1154377430
Name:SUPERABLE, CATHERINE MARZON (PT)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARZON
Last Name:SUPERABLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31-75 29TH ST APT B6
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3331
Mailing Address - Country:US
Mailing Address - Phone:718-932-2471
Mailing Address - Fax:
Practice Address - Street 1:171 EAST 84TH ST.
Practice Address - Street 2:PROFITNESS PHYSICAL THERAPY
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-327-0600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022837-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist