Healthcare Provider Details

I. General information

NPI: 1376216457
Provider Name (Legal Business Name): CAITLIN NICOLE CASAZZA KINESIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 WINDWARD LN STE B
GAINESVILLE GA
30501-7418
US

IV. Provider business mailing address

1000 NEW HOLLAND WAY NE APT 1326
GAINESVILLE GA
30501-0002
US

V. Phone/Fax

Practice location:
  • Phone: 470-252-6710
  • Fax:
Mailing address:
  • Phone: 336-906-8975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: