Provider Demographics
NPI:1073013215
Name:BRAASCH, KRISTEN BLAIR (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BLAIR
Last Name:BRAASCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 GETWELL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-9608
Mailing Address - Country:US
Mailing Address - Phone:662-772-5924
Mailing Address - Fax:662-772-5925
Practice Address - Street 1:909 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-9201
Practice Address - Country:US
Practice Address - Phone:870-936-8000
Practice Address - Fax:870-936-0141
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8789225100000X
ARPT4635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist