Healthcare Provider Details

I. General information

NPI: 1467083782
Provider Name (Legal Business Name): KAITLIN CHRISTINE EMREY PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN CHRISTINE DAVIS

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 BLACK SWAN DRIVE SUITE 202
LEWES DE
19958
US

IV. Provider business mailing address

12100 BLACK SWAN DRIVE SUITE 202
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-5591
  • Fax: 302-449-2047
Mailing address:
  • Phone: 302-644-5591
  • Fax: 302-449-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0004171
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: