Provider Demographics
NPI:1609328236
Name:PAKKALA, CAITLIN (MS, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:
Last Name:PAKKALA
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 MANSIONS BLFS APT 736
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4112
Mailing Address - Country:US
Mailing Address - Phone:248-231-9378
Mailing Address - Fax:
Practice Address - Street 1:2230 HUGHES AVE
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5415
Practice Address - Country:US
Practice Address - Phone:248-231-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer