Healthcare Provider Details

I. General information

NPI: 1588579882
Provider Name (Legal Business Name): KAITIE FAE MCAMIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 WOOD AVE E
BIG STONE GAP VA
24219-3023
US

IV. Provider business mailing address

5431 POLE BRIDGE RD
WISE VA
24293-4333
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-1234
  • Fax:
Mailing address:
  • Phone: 540-520-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217959
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: