Provider Demographics
NPI:1144379074
Name:SPEELMAN, KRISTY LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LEE
Last Name:SPEELMAN
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 1:9973 ELLSWORTH LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8643
Mailing Address - Country:US
Mailing Address - Phone:317-209-1891
Mailing Address - Fax:
Practice Address - Street 1:7950 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2691
Practice Address - Country:US
Practice Address - Phone:317-849-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005681A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist