Provider Demographics
NPI:1780274688
Name:HANLEY, KAITLYN L (DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:L
Last Name:HANLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:L
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8260
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:12162 N RANCHO VISTOSO BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1898
Practice Address - Country:US
Practice Address - Phone:520-229-0009
Practice Address - Fax:520-229-0007
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046545225100000X
AZLPT-32049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046545Other1356530182