Provider Demographics
NPI:1144579236
Name:FAHEY, CAITLIN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:FAHEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:6049 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2160
Practice Address - Country:US
Practice Address - Phone:804-639-2359
Practice Address - Fax:804-639-2029
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305207594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144579236OtherMEDICAID QMB PROVIDER ID
VAC05954OtherGROUP MEDICARE PTAN
VAC05954OtherGROUP MEDICARE PTAN