Provider Demographics
NPI:1134368475
Name:PATRY, CAITLIN F (PT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:F
Last Name:PATRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 KINGS HIGHWAY CUTOFF
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5340
Mailing Address - Country:US
Mailing Address - Phone:203-337-2600
Mailing Address - Fax:203-337-2666
Practice Address - Street 1:75 KINGS HIGHWAY CUTOFF
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5340
Practice Address - Country:US
Practice Address - Phone:203-337-2600
Practice Address - Fax:203-337-2666
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1114979226OtherGROUP NPI NUMBER