Healthcare Provider Details

I. General information

NPI: 1982040846
Provider Name (Legal Business Name): KAITLYN MARTHA BROWN DOCTOR OF PHYSICAL T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN MARTHA SHAFFER DOCTOR OF PHYSICAL T

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 RITTER DRIVE
DANIELS WV
25832
US

IV. Provider business mailing address

1338 RITTER DRIVE
DANIELS WV
25832
US

V. Phone/Fax

Practice location:
  • Phone: 304-237-5585
  • Fax: 681-207-7212
Mailing address:
  • Phone: 304-237-5585
  • Fax: 681-207-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004052
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001831
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: