Provider Demographics
NPI:1083043459
Name:LONG, CAITLYN (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:201 TAHOMA BLVD
Practice Address - Street 2:STE 207
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7735
Practice Address - Country:US
Practice Address - Phone:360-458-6400
Practice Address - Fax:360-458-6444
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WAPT 60419471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1083043459Medicaid
WA0319980OtherDEPT. OF LABOR AND INDUSTRIES
WA0319980OtherDEPT. OF LABOR AND INDUSTRIES