Healthcare Provider Details

I. General information

NPI: 1265215313
Provider Name (Legal Business Name): KAITLIN MARIE THOMAS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN MARIE COLEMAN PT, DPT

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8388 PARKWAY DR
LA MESA CA
91942-2893
US

IV. Provider business mailing address

4825 BELLA PACIFIC ROW UNIT 214
SAN DIEGO CA
92109-8502
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-1190
  • Fax:
Mailing address:
  • Phone: 619-971-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number298426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: