MEDICARE: LISA RENEE CATAROUCHE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	TEI000945	PA

General Provider Information

NPI Number	:	1033777008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENEE CATAROUCHE PTA

Provider Business Mailing Address
First Line	:	302 1/2 CLEVELAND ST
Second Line	:
City	:	PUNXSUTAWNEY
State	:	PA
Zip	:	15767-1830
Country	:	US
Telephone Number	:	814-938-2181
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 1/2 CLEVELAND ST
Second Line	:
City	:	PUNXSUTAWNEY
State	:	PA
Zip	:	15767-1830
Country	:	US
Telephone Number	:	814-938-2181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/04/2019

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