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General NPI Number Information
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NPI Number | 1699232603
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Entity Type | Individual
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Provider Name | CAITLIN JOHNSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 1530 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-3601
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Country | US
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Telephone | 228-864-6544
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Fax |
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Provider Business Mailing Address
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Address Line | 1955 POPPS FERRY RD APT Q2088
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City | BILOXI
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State | MS
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Zip | 39532-2023
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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 | 5815
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License Number State | MS
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