Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | CA | |
N | 2251X0800X | Physical Therapist - Orthopedic | 297674 | CA |
NPI | 1063052173 |
---|---|
Provider Name | Caitlyn Ashlie Wong Catabona |
First Address | Stockton, CA 95207-2015 |
Second Address | Stockton, CA 95209-2368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2020 |
Last Update Date | 09/10/2020 |