Provider Demographics
NPI:1336368133
Name:MCKISSICK, CATRINA M (DPT)
Entity type:Individual
Prefix:MRS
First Name:CATRINA
Middle Name:M
Last Name:MCKISSICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CONKEY AVE
Mailing Address - Street 2:BOX 136
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1756
Mailing Address - Country:US
Mailing Address - Phone:607-432-1558
Mailing Address - Fax:607-432-1566
Practice Address - Street 1:4966 STATE HIGHWAY 23
Practice Address - Street 2:SUITE 3
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3557
Practice Address - Country:US
Practice Address - Phone:607-432-1558
Practice Address - Fax:607-432-1566
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021932-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010021932OtherBLUE CROSS
NY6007836OtherMVP