Healthcare Provider Details

I. General information

NPI: 1003511411
Provider Name (Legal Business Name): CAITLIN SOUTHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 E BAY DR
LARGO FL
33771-1948
US

IV. Provider business mailing address

3391 E BAY DR
LARGO FL
33771-1948
US

V. Phone/Fax

Practice location:
  • Phone: 727-238-3062
  • Fax:
Mailing address:
  • Phone: 727-238-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: