Provider Demographics
NPI:1215525415
Name:RADFORD, CATINA FIONNE (CMT)
Entity type:Individual
Prefix:
First Name:CATINA
Middle Name:FIONNE
Last Name:RADFORD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:CATINA
Other - Middle Name:FIONNE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:303 W 80TH PL UNIT 10072
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-5804
Mailing Address - Country:US
Mailing Address - Phone:219-713-0047
Mailing Address - Fax:
Practice Address - Street 1:7895 BROADWAY STE C
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5529
Practice Address - Country:US
Practice Address - Phone:219-789-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20900536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist