Provider Demographics
NPI:1487492864
Name:SHOLTIS, CAITLIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SHOLTIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 S DONNER WAY APT 209
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2183
Mailing Address - Country:US
Mailing Address - Phone:208-721-7778
Mailing Address - Fax:
Practice Address - Street 1:1280 E STRINGHAM AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2490
Practice Address - Country:US
Practice Address - Phone:801-581-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14001525-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14001525-2401OtherPHYSICAL THERAPIST STATE LICENSE