Provider Demographics
NPI:1073635124
Name:CARITHERS, KRISTEN T (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:T
Last Name:CARITHERS
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 1:9516 ETHAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3510 SUGARLOAF PKWY
Practice Address - Street 2:SUITE G-02
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7910
Practice Address - Country:US
Practice Address - Phone:301-874-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist