Provider Demographics
NPI:1174040851
Name:ROBERTSON, CAITLIN BROOK (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:BROOK
Last Name:ROBERTSON
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 1:2101 BOX BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-4445
Mailing Address - Country:US
Mailing Address - Phone:308-762-6660
Mailing Address - Fax:
Practice Address - Street 1:2101 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-4445
Practice Address - Country:US
Practice Address - Phone:308-762-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1295693208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation