Provider Demographics
NPI:1902453582
Name:ELLIOTT, KAITLYN ROSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 ARBOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2903
Mailing Address - Country:US
Mailing Address - Phone:305-968-8212
Mailing Address - Fax:
Practice Address - Street 1:1615 RIDENOUR BLVD NW STE 204
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4464
Practice Address - Country:US
Practice Address - Phone:770-580-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist