Provider Demographics
NPI:1144950874
Name:IDLEMAN, CAITLYN DANAE (LMT)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:DANAE
Last Name:IDLEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S HOLLAND LN STE 407
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2060
Mailing Address - Country:US
Mailing Address - Phone:316-737-0160
Mailing Address - Fax:
Practice Address - Street 1:520 S HOLLAND LN STE 407
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2060
Practice Address - Country:US
Practice Address - Phone:316-737-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist