Provider Demographics
NPI:1700379674
Name:BROOKS, CAITLIN KATHLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:KATHLEEN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:K
Other - Last Name:FORTUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1350 S KING ST STE 307
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2008
Mailing Address - Country:US
Mailing Address - Phone:808-285-9282
Mailing Address - Fax:
Practice Address - Street 1:1350 S KING ST STE 307
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2008
Practice Address - Country:US
Practice Address - Phone:808-342-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5408-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist