Provider Demographics
NPI:1992213110
Name:EMERY, CAITLIN ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ROSE
Last Name:EMERY
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 1:5605 W EUGIE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1275
Mailing Address - Country:US
Mailing Address - Phone:608-865-5830
Mailing Address - Fax:
Practice Address - Street 1:5605 W EUGIE AVE STE 212
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1275
Practice Address - Country:US
Practice Address - Phone:608-865-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist