Provider Demographics
NPI:1700293040
Name:MARINANGELI, KAITLIN (PT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MARINANGELI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:750 PRIDES XING
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-6104
Mailing Address - Country:US
Mailing Address - Phone:302-864-2222
Mailing Address - Fax:
Practice Address - Street 1:750 PRIDES XING STE 112
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6107
Practice Address - Country:US
Practice Address - Phone:302-864-2222
Practice Address - Fax:410-569-2689
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25359225100000X
DE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE368116Y0XMedicare PIN