Healthcare Provider Details

I. General information

NPI: 1851861454
Provider Name (Legal Business Name): CATHERINE MARY POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N OCEAN AVE STE 4
PATCHOGUE NY
11772-2016
US

IV. Provider business mailing address

157 N OCEAN AVE STE 4
PATCHOGUE NY
11772-2016
US

V. Phone/Fax

Practice location:
  • Phone: 631-317-1222
  • Fax:
Mailing address:
  • Phone: 631-317-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: