Provider Demographics
NPI:1932670973
Name:ENDO, KAITLIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:ENDO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 DIABLO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3410
Mailing Address - Country:US
Mailing Address - Phone:925-552-5787
Mailing Address - Fax:925-552-6173
Practice Address - Street 1:380 DIABLO RD STE 201
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3410
Practice Address - Country:US
Practice Address - Phone:925-552-5787
Practice Address - Fax:925-552-6173
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist