Provider Demographics
NPI:1992956890
Name:ADRIAN, CATHERINE A
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:ADRIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 PRINCETON BLVD APT 6
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2058
Mailing Address - Country:US
Mailing Address - Phone:774-264-1251
Mailing Address - Fax:
Practice Address - Street 1:736 PRINCETON BLVD APT 6
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2058
Practice Address - Country:US
Practice Address - Phone:774-264-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40404000Medicaid