Provider Demographics
NPI:1437919990
Name:THOMPSON, KAITLIN ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 E FLYNN ST
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2425
Mailing Address - Country:US
Mailing Address - Phone:563-451-5847
Mailing Address - Fax:
Practice Address - Street 1:1002 S 4TH ST
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:KS
Practice Address - Zip Code:67070-1825
Practice Address - Country:US
Practice Address - Phone:620-825-4131
Practice Address - Fax:820-860-8065
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06840225100000X
IL070.021034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist