Provider Demographics
NPI:1558240945
Name:VLIEGER, KAITLYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:VLIEGER
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 1:23920 ANZA AVE APT 141
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5731
Mailing Address - Country:US
Mailing Address - Phone:310-961-6493
Mailing Address - Fax:
Practice Address - Street 1:23920 ANZA AVE APT 141
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5731
Practice Address - Country:US
Practice Address - Phone:310-961-6493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308701208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty