Healthcare Provider Details

I. General information

NPI: 1770006819
Provider Name (Legal Business Name): CATHERINE SOPHIA SOUSA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FOULK RD
WILMINGTON DE
19803-3158
US

IV. Provider business mailing address

22 LOCHARRON DR
ELKTON MD
21921-2983
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-1536
  • Fax:
Mailing address:
  • Phone: 301-351-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003750
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: