Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1285482 | TX |
Y | 2251X0800X | Physical Therapist - Orthopedic | 0015282 | CO |
NPI | 1003352550 |
---|---|
Provider Name | Dr. Caitlyn Christine Tivy |
First Address | Basalt, CO 81621-8352 |
Second Address | Basalt, CO 81621-8352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2017 |
Last Update Date | 13/11/2019 |