Provider Demographics
NPI:1174067953
Name:KING, CAITLIN A (DPT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:A
Last Name:KING
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 1:224 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4288
Mailing Address - Country:US
Mailing Address - Phone:706-235-2727
Mailing Address - Fax:706-235-2726
Practice Address - Street 1:8250 GREENSBORO DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4902
Practice Address - Country:US
Practice Address - Phone:703-388-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012696225100000X
VA2305211598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT012696OtherLICENSE NUMBER