Provider Demographics
NPI:1780133421
Name:BRICKEY, KAITLIN ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:BRICKEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:REIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 DIABLO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:380 DIABLO RD STE 201
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526
Practice Address - Country:US
Practice Address - Phone:925-552-5787
Practice Address - Fax:805-788-0845
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist