Basic Information
Provider Information | |||||||||
NPI: | 1275653545 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SALEMI | ||||||||
FirstName: | CATHERINE | ||||||||
MiddleName: | RUTH | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NICHOLS | ||||||||
OtherFirstName: | CATHERINE | ||||||||
OtherMiddleName: | RUTH | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MSPT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 435 HARTFORD TPKE | ||||||||
Address2: | SUITE U | ||||||||
City: | VERNON | ||||||||
State: | CT | ||||||||
PostalCode: | 060664852 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8609791611 | ||||||||
FaxNumber: | 2038663014 | ||||||||
Practice Location | |||||||||
Address1: | 435 HARTFORD TPKE | ||||||||
Address2: | SUITE U | ||||||||
City: | VERNON | ||||||||
State: | CT | ||||||||
PostalCode: | 060664852 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8608708272 | ||||||||
FaxNumber: | 8608750804 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/30/2007 | ||||||||
LastUpdateDate: | 01/26/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 006644 | CT | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 006644 | 01 | CT | CT PT LICENSE | OTHER |