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General NPI Number Information
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NPI Number | 1174280127
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Entity Type | Individual
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Provider Name | KAITLIN BLUM PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 4000 CALLE TECATE STE 117
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City | CAMARILLO
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State | CA
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Zip | 93012-5285
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Country | US
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Telephone | 805-383-0470
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Fax | 805-856-1582
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Provider Business Mailing Address
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Address Line | 416 PIONEER DR APT 6
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City | GLENDALE
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State | CA
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Zip | 91203-1723
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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