Healthcare Provider Details

I. General information

NPI: 1356830053
Provider Name (Legal Business Name): CAITLIN MARIE FLATLEY LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE MARIE FLATLEY LAT, ATC

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIDDLE AVE CONNER BUILDING
NEWARK DE
19702
US

IV. Provider business mailing address

1400 N WASHINGTON ST
WILMINGTON DE
19801-1024
US

V. Phone/Fax

Practice location:
  • Phone: 302-838-4750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberJ3-0000710
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: