Provider Demographics
NPI:1083272629
Name:RIOS, KAITLYN MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MICHELLE
Last Name:RIOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 OLD GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-2007
Mailing Address - Country:US
Mailing Address - Phone:813-842-8997
Mailing Address - Fax:
Practice Address - Street 1:2419 W SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1505
Practice Address - Country:US
Practice Address - Phone:817-809-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1258566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist