Provider Demographics
NPI:1780294280
Name:PROCTOR, KAITLIN ELIZABETH (DPT)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 BOYMEL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5526
Mailing Address - Country:US
Mailing Address - Phone:513-870-5342
Mailing Address - Fax:
Practice Address - Street 1:5900 BOYMEL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5526
Practice Address - Country:US
Practice Address - Phone:513-870-5342
Practice Address - Fax:513-870-5343
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013894A225100000X
OHPT018760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist