Healthcare Provider Details

I. General information

NPI: 1831647502
Provider Name (Legal Business Name): CAITLIN RIPLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN MAAT

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10402 BRISTOW CENTER DR
BRISTOW VA
20136-2202
US

IV. Provider business mailing address

2468 MOUNT CARMEL RD
BLUEMONT VA
20135-5204
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-0261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604553
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: