Provider Demographics
NPI:1336703495
Name:SANFILIPPO, KAITLYN (MA, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JAMES LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-7652
Mailing Address - Country:US
Mailing Address - Phone:803-466-0513
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY DR # 823
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2190
Practice Address - Country:US
Practice Address - Phone:803-466-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT12132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer