Provider Demographics
NPI:1083294839
Name:DUCKWORTH, KAITLYN (DPT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:DUCKWORTH
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 1:3633 VISTA WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4568
Mailing Address - Country:US
Mailing Address - Phone:760-729-7298
Mailing Address - Fax:760-729-7206
Practice Address - Street 1:1025 SERVICE PL STE 200
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-7271
Practice Address - Country:US
Practice Address - Phone:760-842-8824
Practice Address - Fax:760-650-7788
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2997502251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports