Provider Demographics
NPI:1396221628
Name:IVESTER, CAITLYN RENEE
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:RENEE
Last Name:IVESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 WILD WOLF RUN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6475
Mailing Address - Country:US
Mailing Address - Phone:828-557-8794
Mailing Address - Fax:
Practice Address - Street 1:2810 W US HIGHWAY 64 STE 1
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-4061
Practice Address - Country:US
Practice Address - Phone:828-837-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6701225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant