1649073396 NPI number — DR. KAITLIN JAN THRELKELD RODI PT, DPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649073396 NPI number — DR. KAITLIN JAN THRELKELD RODI PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODI
Provider First Name:
KAITLIN
Provider Middle Name:
JAN THRELKELD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649073396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4110 PEBBLE CREEK LN APT 3B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKWOOD
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30566-6206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-943-5574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 JOHN W MORROW JR PKWY STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501-8532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-862-0007
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT016794 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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