Individual
CAITLIN M. FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
6049 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2160
(804) 639-2359
(804) 639-2029
Mailing address
771 PILOT HOUSE DR, SUITE A, NEWPORT NEWS, VA 23606-1990
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207594
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144579236
MEDICAID QMB PROVIDER ID
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
09/05/2012
Last updated
11/06/2015
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