Provider Demographics
NPI:1003177627
Name:DOWNEY, KRISTEN HONEYCUTT (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HONEYCUTT
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:HONEYCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3036 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-4384
Mailing Address - Country:US
Mailing Address - Phone:941-627-1650
Mailing Address - Fax:941-627-1507
Practice Address - Street 1:3036 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-4384
Practice Address - Country:US
Practice Address - Phone:941-627-1650
Practice Address - Fax:941-627-1507
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5366225100000X
FLPT29729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist