Provider Demographics
NPI:1548915721
Name:HIDDE, CAITLIN (DPT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:HIDDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 MARBON ESTATES LN S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-4829
Mailing Address - Country:US
Mailing Address - Phone:904-599-8583
Mailing Address - Fax:
Practice Address - Street 1:999 CROSSWATER PKWY
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32081-1800
Practice Address - Country:US
Practice Address - Phone:775-367-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist