Provider Demographics
NPI:1760921084
Name:NEELY, CAITLIN COLLINS (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:COLLINS
Last Name:NEELY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-0608
Mailing Address - Country:US
Mailing Address - Phone:423-317-7772
Mailing Address - Fax:423-317-7773
Practice Address - Street 1:1009 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3525
Practice Address - Country:US
Practice Address - Phone:865-518-6791
Practice Address - Fax:423-317-7773
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT11182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist