Cathy Poerner Supak, ATC, LAT
Individual provider Active NPI Athletic Trainer · Houston, TX
NPI 1164570263 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164570263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT-0797 (TX)
- Practice address
- 18100 Saint John Dr
Suite 100
Houston, TX 77058-3631 - Phone
- (281) 333-8806
- Fax
- (281) 333-8875
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-0797 | TX | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Houston Methodist St. John Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT-0797 | TX | Yes |
Addresses
Primary practice location
18100 Saint John Dr
Suite 100
Houston, TX 77058-3631
Mailing address
14714 Graywood Grove LN
Houston, TX 77062-2108
Phone (281) 480-1417
Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.