Provider Demographics
NPI:1558804419
Name:AMRINE, KAITLIN (DPT)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:
Last Name:AMRINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:NAVAJO HEALTH FOUNDATION/SAGE MEMORIAL HOSPITAL
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0457
Mailing Address - Country:US
Mailing Address - Phone:928-755-4500
Mailing Address - Fax:928-755-4847
Practice Address - Street 1:ARIZONA HIGHWAY 264 & 191
Practice Address - Street 2:NAVAJO HEALTH FOUNDATION/SAGE MEMORIAL HOSPITAL
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-0457
Practice Address - Country:US
Practice Address - Phone:928-755-4500
Practice Address - Fax:928-755-4847
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ12625PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist