Provider Demographics
NPI:1225677339
Name:BERNER, KRISTEN J (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:J
Last Name:BERNER
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 1:41 ARTERIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-2512
Mailing Address - Country:US
Mailing Address - Phone:518-775-9554
Mailing Address - Fax:518-773-7747
Practice Address - Street 1:41 ARTERIAL PLZ
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-2512
Practice Address - Country:US
Practice Address - Phone:518-775-9554
Practice Address - Fax:518-773-7747
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist