Basic Information
| Provider Information | |||||||||
| NPI: | 1871517508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWBERG | ||||||||
| FirstName: | CATHLEEN | ||||||||
| MiddleName: | RENATA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 GLOUCESTER DR | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254012983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042675800 | ||||||||
| FaxNumber: | 3042626036 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 GLOUCESTER DR | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254012983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042675800 | ||||||||
| FaxNumber: | 3042626036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 002178 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251G0304X | 002178 | WV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
ID Information
| ID | Type | State | Issuer | Description | KBC4H0-65049301 | 01 | MD | BC/BS OF MARYLAND | OTHER | S404-0026 | 01 | MD | CAREFIRST BC/BS | OTHER |