Provider Demographics
NPI:1609126986
Name:MULLOOLY, CATHERINE ANN (RCEP, CDE)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
Last Name:MULLOOLY
Suffix:
Gender:F
Credentials:RCEP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0829
Mailing Address - Country:US
Mailing Address - Phone:781-894-0315
Mailing Address - Fax:
Practice Address - Street 1:80 SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0829
Practice Address - Country:US
Practice Address - Phone:781-894-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist