Healthcare Provider Details

I. General information

NPI: 1881205342
Provider Name (Legal Business Name): KAITLIN MARIE LOWERY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 CROSSINGS MALL RD
ELKVIEW WV
25071-9230
US

IV. Provider business mailing address

213 CROSSINGS MALL RD
ELKVIEW WV
25071-9230
US

V. Phone/Fax

Practice location:
  • Phone: 304-965-7979
  • Fax: 304-965-3239
Mailing address:
  • Phone: 304-965-7979
  • Fax: 304-965-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004316
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: