Provider Demographics
NPI:1316399884
Name:GRAYBILL, KAITLYN ALEXANDRA (ATC, VATL)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALEXANDRA
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11204 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5405
Mailing Address - Country:US
Mailing Address - Phone:703-273-8787
Mailing Address - Fax:
Practice Address - Street 1:11204 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5405
Practice Address - Country:US
Practice Address - Phone:703-273-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260024592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer