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NPI Code Detail

MEDICARE: CAITLIN CYRUS

MEDICARE: CAITLIN CYRUS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerSD

General Provider Information

NPI Number : 1376475277
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAITLIN CYRUS
Provider Business Mailing Address
First Line : 1123 LINCOLN AVE NE
Second Line :
City : WATERTOWN
State : SD
Zip : 57201-7397
Country : US
Telephone Number : 808-597-7023
Fax Number :
Provider Business Practice Location Address
First Line : 401 9TH AVE NW BLDG B
Second Line :
City : WATERTOWN
State : SD
Zip : 57201-1548
Country : US
Telephone Number : 605-882-7777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ CAITLIN CYRUS ” Practice Location

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