Provider Demographics
NPI:1982040846
Name:BROWN, KAITLYN MARTHA (DOCTOR OF PHYSICAL T)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:MARTHA
Last Name:BROWN
Suffix:
Gender:F
Credentials:DOCTOR OF PHYSICAL T
Other - Prefix:MRS
Other - First Name:KAITLYN
Other - Middle Name:MARTHA
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOCTOR OF PHYSICAL T
Mailing Address - Street 1:1338 RITTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832
Mailing Address - Country:US
Mailing Address - Phone:304-237-5585
Mailing Address - Fax:681-207-7212
Practice Address - Street 1:1338 RITTER DRIVE
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832
Practice Address - Country:US
Practice Address - Phone:304-237-5585
Practice Address - Fax:681-207-7212
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001831225200000X
WVPT004052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant