Provider Demographics
NPI:1386182475
Name:NOLAN, KAITLYN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 GREENVILLE AVE
Mailing Address - Street 2:APT 3171
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-0100
Mailing Address - Country:US
Mailing Address - Phone:512-745-1955
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 4000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:214-820-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1287258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist