Provider Demographics
NPI:1356830053
Name:FLATLEY, CAITLIN MARIE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:FLATLEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:FLATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:1400 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 BIDDLE AVE
Practice Address - Street 2:CONNER BUILDING
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-838-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-0000710207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine