Provider Demographics
NPI:1669176848
Name:THE PHYSIO TUNE
Entity type:Organization
Organization Name:THE PHYSIO TUNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:603-892-0708
Mailing Address - Street 1:PO BOX 3836
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-3836
Mailing Address - Country:US
Mailing Address - Phone:603-892-0708
Mailing Address - Fax:
Practice Address - Street 1:174 N KING ST # 203
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8553
Practice Address - Country:US
Practice Address - Phone:603-892-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy