Provider Demographics
NPI:1194205070
Name:ROBERTS, KRISTIN PHILLIPS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PHILLIPS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36932 SILICATO DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966
Mailing Address - Country:US
Mailing Address - Phone:302-947-0781
Mailing Address - Fax:
Practice Address - Street 1:36932 SILICATO DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-947-0781
Practice Address - Fax:302-947-0761
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist