Healthcare Provider Details

I. General information

NPI: 1750454617
Provider Name (Legal Business Name): CATHERINE M CAHILL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 SAN VICENTE BLVD #205
LOS ANGELES CA
90049-6610
US

IV. Provider business mailing address

10539 LAURISTON AVE
LOS ANGELES CA
90064-2314
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-7602
  • Fax: 310-820-7818
Mailing address:
  • Phone: 310-490-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: