Healthcare Provider Details

I. General information

NPI: 1609415256
Provider Name (Legal Business Name): KAITLYN HUFF LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27018 LEE HWY
ABINGDON VA
24211-7512
US

IV. Provider business mailing address

PO BOX 462
PENNINGTON GAP VA
24277-0462
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: