Provider Demographics
NPI:1407461759
Name:STUMP, KAITLIN LOUISE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:LOUISE
Last Name:STUMP
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 1:17496 BEAR DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MO
Mailing Address - Zip Code:63548-4206
Mailing Address - Country:US
Mailing Address - Phone:660-342-5105
Mailing Address - Fax:
Practice Address - Street 1:1108 E PATTERSON ST STE 6
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4010
Practice Address - Country:US
Practice Address - Phone:660-665-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist