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General NPI Number Information
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NPI Number | 1407556228
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Entity Type | Individual
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Provider Name | KAITLYN WEATHERBY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 1500 ALMONESSON RD STE 7
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City | DEPTFORD
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State | NJ
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Zip | 08096-5260
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Country | US
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Telephone | 856-352-0621
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Fax |
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Provider Business Mailing Address
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Address Line | 220 SALINA RD
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City | SEWELL
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State | NJ
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Zip | 08080-4100
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Country | US
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Telephone | 856-952-5223
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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 | 40QA02154700
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License Number State | NJ
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