Provider Demographics
NPI:1114096476
Name:RIPLEY, KRISTIN DENISE (ATC, LMT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DENISE
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1708
Mailing Address - Country:US
Mailing Address - Phone:574-286-0859
Mailing Address - Fax:
Practice Address - Street 1:2403 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-2305
Practice Address - Country:US
Practice Address - Phone:574-286-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001015A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36001015AOtherSTATE LICENSE