Provider Demographics
NPI:1003668468
Name:CREECH, KRISTEN (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CREECH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 DURVIN DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3316
Mailing Address - Country:US
Mailing Address - Phone:804-221-9405
Mailing Address - Fax:
Practice Address - Street 1:8003 FRANKLIN FARMS DR RM 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5107
Practice Address - Country:US
Practice Address - Phone:804-945-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604868225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant