Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 313 | AK |
Y | 2251X0800X | Physical Therapist - Orthopedic | PSYP313 | AK |
N | 225X00000X | Occupational Therapist | 354 | AK |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | PSYO354 | AK |
NPI | 1104888346 |
---|---|
Provider Name | Catherine S Mormile |
First Address | Palmer, AK 99645 |
Second Address | Anchorage, AK 99503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209367 | PHP GENERIC ID (01) | |
75-1754187 | TAX ID (01) | AK |
K0000WCKJT | MEDICARE GROUP (01) | AK |
PT0313 | (05) | AK |