Provider Demographics
NPI:1043821481
Name:CURTIS, KAITLYN NICOLE (PTA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:NICOLE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:NICOLE
Other - Last Name:BARONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:688 W HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-8513
Mailing Address - Country:US
Mailing Address - Phone:660-654-1148
Mailing Address - Fax:
Practice Address - Street 1:1337 W GRAND ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-8320
Practice Address - Country:US
Practice Address - Phone:660-663-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014037269225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant