Healthcare Provider Details

I. General information

NPI: 1225590680
Provider Name (Legal Business Name): CAITLYN FRIDAY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 PROFESSIONAL PLZ STE 110
ASHBURN VA
20147-3409
US

IV. Provider business mailing address

PO BOX 37189
BALTIMORE MD
21297-3189
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-0003
  • Fax: 703-726-6444
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1316715
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214898
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: