1740821305 NPI number — CAITLIN OLIVER MCBRYDE PT, DPT

Table of content: CAITLIN OLIVER MCBRYDE PT, DPT (NPI 1740821305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740821305 NPI number — CAITLIN OLIVER MCBRYDE PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCBRYDE
Provider First Name:
CAITLIN
Provider Middle Name:
OLIVER
Provider Name Prefix Text:
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:
OLIVER
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
RENEE'
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740821305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8205 PRESIDENTS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMMELSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17036-8621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-839-2159
Provider Business Mailing Address Fax Number:
717-565-1104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 1ST ST N STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALABASTER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35007-8944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-358-9138
Provider Business Practice Location Address Fax Number:
205-358-9139
Provider Enumeration Date:
10/04/2019

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:  PTH6926 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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