Provider Demographics
NPI:1114539582
Name:FERRELL, KRISTIN RENAE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:RENAE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LEXINGTON DR STE H
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6646
Mailing Address - Country:US
Mailing Address - Phone:601-910-7300
Mailing Address - Fax:601-910-7071
Practice Address - Street 1:105 LEXINGTON DR STE H
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6646
Practice Address - Country:US
Practice Address - Phone:601-910-7300
Practice Address - Fax:601-910-7071
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist