Provider Demographics
NPI:1811544190
Name:DOERGES, KAITLIN R (DPT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:R
Last Name:DOERGES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 AMELIA DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-8327
Mailing Address - Country:US
Mailing Address - Phone:563-451-6984
Mailing Address - Fax:
Practice Address - Street 1:3485 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1312
Practice Address - Country:US
Practice Address - Phone:563-557-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist