Provider Demographics
NPI:1326650839
Name:CRESWELL, CAITLYN (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:CRESWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:STURGIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 TOWN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3487
Mailing Address - Country:US
Mailing Address - Phone:706-690-4372
Mailing Address - Fax:
Practice Address - Street 1:415 TOWN PARK BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3487
Practice Address - Country:US
Practice Address - Phone:706-690-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist