Healthcare Provider Details

I. General information

NPI: 1417402710
Provider Name (Legal Business Name): KAITLYN A BROWN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN R ADAM PT, DPT

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 CONCORD AVE
CAMBRIDGE MA
02138-1048
US

IV. Provider business mailing address

2023 NORTHWOOD DR
WILLIAMSVILLE NY
14221-3882
US

V. Phone/Fax

Practice location:
  • Phone: 617-868-2200
  • Fax:
Mailing address:
  • Phone: 585-690-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22598
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number044028-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: