Provider Demographics
NPI:1992065726
Name:RADA, CATHERINE SUZANNE (PT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUZANNE
Last Name:RADA
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 1:3 HANNAH COLE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5162
Mailing Address - Country:US
Mailing Address - Phone:843-906-3580
Mailing Address - Fax:
Practice Address - Street 1:3 HANNAH COLE DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5162
Practice Address - Country:US
Practice Address - Phone:843-906-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist