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General NPI Number Information
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NPI Number | 1629638333
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Entity Type | Individual
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Provider Name | KAITLIN OLIVIA CORDOVA PT DPT
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Gender | Female
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 1128 WINCHESTER RD STE 110
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City | LEXINGTON
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State | KY
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Zip | 40505-4052
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Country | US
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Telephone | 859-539-3305
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Fax | 855-978-1372
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Provider Business Mailing Address
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Address Line | 149 OLD TOWNE WALK APT 5302
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City | LEXINGTON
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State | KY
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Zip | 40511-2190
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Country | US
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Telephone | 859-539-3305
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Fax | 855-978-1372
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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 | 007685
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License Number State | KY
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