MEDICARE: KAITLIN OLIVIA CORDOVA PT DPT

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
1	225100000X	Physical Therapist	007685	KY

General Provider Information

NPI Number	:	1629638333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN OLIVIA CORDOVA PT DPT

Provider Business Mailing Address
First Line	:	149 OLD TOWNE WALK APT 5302
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-2190
Country	:	US
Telephone Number	:	859-539-3305
Fax Number	:	855-978-1372

Provider Business Practice Location Address
First Line	:	1128 WINCHESTER RD STE 110
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4052
Country	:	US
Telephone Number	:	859-539-3305
Fax Number	:	855-978-1372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	05/28/2025

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