Provider Demographics
NPI:1043492952
Name:CULLEN, CATHERINE WALVOORD (DPT, RYT)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:WALVOORD
Last Name:CULLEN
Suffix:
Gender:F
Credentials:DPT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 HIGH HOUSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3576
Mailing Address - Country:US
Mailing Address - Phone:919-415-1318
Mailing Address - Fax:
Practice Address - Street 1:981 HIGH HOUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3510
Practice Address - Country:US
Practice Address - Phone:919-388-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22335174400000X
NC11866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD189PMedicare UPIN