Provider Demographics
NPI:1003352550
Name:TIVY, CAITLYN CHRISTINE (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:CHRISTINE
Last Name:TIVY
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:979 E VALLEY RD APT 303
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-7611
Practice Address - Country:US
Practice Address - Phone:815-814-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2399225100000X
HIPT-5269225100000X
MN12510225100000X
WYPT-2112225100000X
NJ40QA02061400225100000X
FLPT38209225100000X
AK180422225100000X
TX1285482225100000X
MI5501021642225100000X
CA301152225100000X
CO00152822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist