Provider Demographics
NPI:1770980567
Name:DUTROW, CAITLIN (DPT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:DUTROW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:ROXBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22830 & 22832 SUSSEX HIGHWAY
Practice Address - Street 2:SUITES 13 & 14
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5862
Practice Address - Country:US
Practice Address - Phone:302-536-5562
Practice Address - Fax:302-628-5313
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003248225100000X
MD25696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE390896Y0XMedicare PIN