Provider Demographics
NPI:1982144507
Name:NAVATTO, KAITLYN MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MICHELLE
Last Name:NAVATTO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-1244
Mailing Address - Country:US
Mailing Address - Phone:518-622-9200
Mailing Address - Fax:518-622-9945
Practice Address - Street 1:4383 ROUTE 23
Practice Address - Street 2:SUITE 102
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2680
Practice Address - Country:US
Practice Address - Phone:518-622-9200
Practice Address - Fax:518-622-9945
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010012225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0WKY1Medicare UPIN