Most Relevant Information
Provider Data
| NPI Number: | 1003352550 |
| Provider Name: | CAITLYN CHRISTINE TIVY PT, DPT, OCS |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 2399 |
Most Important Dates
| Enumeration Date: | 01/09/2017 |
| Last Updated: | 03/15/2022 |
Provider Practice Location
979 E VALLEY RD APT 303
BASALT
CO
816217611
Practice Location Phone/Fax
| Phone: | 8158143786 |
| Fax: |
Provider Mailing Location
65 E WADSWORTH PARK DR STE 230
DRAPER
UT
840208096
Provider Mailing Phone/Fax
| Phone: | 3853088034 |
| Fax: |