Provider Demographics
NPI:1730704602
Name:MORELAND, CAITLIN ALYSSE (DPT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ALYSSE
Last Name:MORELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:90 E USTICK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6134
Mailing Address - Country:US
Mailing Address - Phone:208-895-0715
Mailing Address - Fax:208-895-0746
Practice Address - Street 1:1015 12TH AVE S STE 105
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4660
Practice Address - Country:US
Practice Address - Phone:208-467-4357
Practice Address - Fax:208-467-4395
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4303225100000X
ID7251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist