Provider Demographics
NPI:1073784740
Name:FREDRIKSEN, KRISTEN D (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:FREDRIKSEN
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 1:535 CENTERVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4376
Mailing Address - Country:US
Mailing Address - Phone:401-737-6011
Mailing Address - Fax:401-737-4811
Practice Address - Street 1:535 CENTERVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4376
Practice Address - Country:US
Practice Address - Phone:401-737-6011
Practice Address - Fax:401-737-4811
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist