Healthcare Provider Details

I. General information

NPI: 1891009015
Provider Name (Legal Business Name): CAITLIN ELIZABETH KOTHE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE STE 1210 STE 1210
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

4444 FOREST PARK AVE C B 8502
SAINT LOUIS MO
63108-2212
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1940
  • Fax: 314-286-1473
Mailing address:
  • Phone: 314-286-1940
  • Fax: 314-286-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2010024970
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: