Provider Demographics
NPI:1215360433
Name:TERRELL, KRISTIN ANITA (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANITA
Last Name:TERRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ANITA
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:148 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6519
Mailing Address - Country:US
Mailing Address - Phone:781-862-5619
Mailing Address - Fax:
Practice Address - Street 1:148 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6519
Practice Address - Country:US
Practice Address - Phone:781-862-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist