Provider Demographics
NPI:1053171496
Name:CARUGATI, MARY KATE
Entity type:Individual
Prefix:MRS
First Name:MARY KATE
Middle Name:
Last Name:CARUGATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATE
Other - Last Name:TINNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19579 W TREEND RD
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7828
Mailing Address - Country:US
Mailing Address - Phone:208-477-1060
Mailing Address - Fax:
Practice Address - Street 1:19579 W TREEND RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7828
Practice Address - Country:US
Practice Address - Phone:208-477-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist