Provider Demographics
NPI:1336515238
Name:YACKULICH, CAITLYN M (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:M
Last Name:YACKULICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:NAPOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:114 WELTON WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9251
Mailing Address - Country:US
Mailing Address - Phone:704-660-6551
Mailing Address - Fax:704-660-9894
Practice Address - Street 1:114 WELTON WAY
Practice Address - Street 2:SUITE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9251
Practice Address - Country:US
Practice Address - Phone:704-660-6551
Practice Address - Fax:704-660-9894
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18068208100000X
NCP18068225100000X
TX1276510225100000X
HI4283225100000X
NY039148-1225100000X
VA2305209730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation