Provider Demographics
NPI:1306207543
Name:DEGRAY, CAITLIN ROSE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:ROSE
Last Name:DEGRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:CAITLIN
Other - Middle Name:ROSE
Other - Last Name:FYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:499 FARMINGTON AVE. SUITE 300
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-549-8986
Mailing Address - Fax:860-284-9630
Practice Address - Street 1:499 FARMINGTON AVE. SUITE 300
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-549-8986
Practice Address - Fax:860-284-9630
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist