Provider Demographics
NPI:1083634539
Name:DUPONT, KRISTEN KAE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAE
Last Name:DUPONT
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 1:400 COLLINS RD NE BLDG 154-100
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52498-0001
Mailing Address - Country:US
Mailing Address - Phone:319-295-8899
Mailing Address - Fax:319-295-8833
Practice Address - Street 1:400 COLLINS RD NE BLDG 154-100
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52498-0001
Practice Address - Country:US
Practice Address - Phone:319-295-8899
Practice Address - Fax:319-295-8833
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37851OtherBCBS
IAI14608Medicare ID - Type Unspecified