MEDICARE: CATHERINE JEAN PATILLO LMT, NCTMB, CHT

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	225700000X	Massage Therapist	372434-4701	UT

General Provider Information

NPI Number	:	1598066052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE JEAN PATILLO LMT, NCTMB, CHT

Provider Business Mailing Address
First Line	:	4149 S 570 E
Second Line	:	18I
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6539
Country	:	US
Telephone Number	:	801-864-4545
Fax Number	:

Provider Business Practice Location Address
First Line	:	4149 S 570 E
Second Line	:	18I
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6539
Country	:	US
Telephone Number	:	801-864-4545
Fax Number	:

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

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/15/2010

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