Provider Demographics
NPI:1164702247
Name:DUROSS, KAITLIN BROOKE (BHS, DPT)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:BROOKE
Last Name:DUROSS
Suffix:
Gender:F
Credentials:BHS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833-0124
Mailing Address - Country:US
Mailing Address - Phone:609-233-5923
Mailing Address - Fax:
Practice Address - Street 1:103 FRAM ST.
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:AK
Practice Address - Zip Code:99833-9983
Practice Address - Country:US
Practice Address - Phone:907-772-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2530225100000X
CT009159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist