Provider Demographics
NPI:1629638333
Name:CORDOVA, KAITLIN OLIVIA (PT DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:OLIVIA
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:149 OLD TOWNE WALK APT 5302
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2190
Mailing Address - Country:US
Mailing Address - Phone:859-539-3305
Mailing Address - Fax:855-978-1372
Practice Address - Street 1:1128 WINCHESTER RD STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4052
Practice Address - Country:US
Practice Address - Phone:859-539-3305
Practice Address - Fax:855-978-1372
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY007685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist