Provider Demographics
NPI:1033285580
Name:FARMER VONDERHEID, KRISTEN E (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:FARMER VONDERHEID
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:E
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1086 ROUTE 315
Mailing Address - Street 2:PRO REHABILITATION SERVICES
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-823-7761
Mailing Address - Fax:570-822-8033
Practice Address - Street 1:1086 ROUTE 315
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-823-7761
Practice Address - Fax:570-822-8033
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012548L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
397923OtherHEALTH AMERICA ASSURANCE
442525OtherHEALTH AMERICA ASSURANCE
442570OtherHEALTH AMERICA ASSURANCE
1349072OtherBLUE SHIELD
820172OtherFIRST PRIORITY
820171OtherFIRST PRIORITY
820173OtherFIRST PRIORITY