Provider Demographics
NPI:1578978789
Name:GAITHER, KAITLYN MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:GAITHER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:304 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3311
Mailing Address - Country:US
Mailing Address - Phone:501-358-2091
Mailing Address - Fax:
Practice Address - Street 1:120 HIGHWAY 201 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3158
Practice Address - Country:US
Practice Address - Phone:870-701-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP005096T225100000X
ARPT4658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist