MEDICARE: CATHERINE DINELLE JEROME LMP

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	172M00000X	Mechanotherapist	MA00008241	WA

General Provider Information

NPI Number	:	1548471790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE DINELLE JEROME LMP

Provider Business Mailing Address
First Line	:	2603 BRIDGEPORT WAY W
Second Line	:	SUITE A
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4724
Country	:	US
Telephone Number	:	253-566-1232
Fax Number	:	253-566-3164

Provider Business Practice Location Address
First Line	:	2603 BRIDGEPORT WAY W
Second Line	:	SUITE A
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4724
Country	:	US
Telephone Number	:	253-566-1232
Fax Number	:	253-566-3164

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

Provider Enumeration Date	:	05/26/2007
Last Update Date	:	07/08/2007

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