Healthcare Provider Details

I. General information

NPI: 1609126986
Provider Name (Legal Business Name): CATHERINE ANN MULLOOLY RCEP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEMINOLE AVE
WALTHAM MA
02451-0829
US

IV. Provider business mailing address

80 SEMINOLE AVE
WALTHAM MA
02451-0829
US

V. Phone/Fax

Practice location:
  • Phone: 781-894-0315
  • Fax:
Mailing address:
  • Phone: 781-894-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: