Provider Demographics
NPI:1255606836
Name:MYERS, CAITLIN CAPISTRAN (DPT)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:CAPISTRAN
Last Name:MYERS
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 1:1318 SE COURTNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8409
Mailing Address - Country:US
Mailing Address - Phone:503-479-8349
Mailing Address - Fax:503-386-0124
Practice Address - Street 1:959 SE DIVISION ST STE 315
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4673
Practice Address - Country:US
Practice Address - Phone:503-479-8349
Practice Address - Fax:503-386-0124
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009294225100000X
OR60672261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist