Provider Demographics
NPI:1235600123
Name:SMITH, KRISTEN DUNFORD (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DUNFORD
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:DUNFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2722 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4039
Mailing Address - Country:US
Mailing Address - Phone:336-317-1770
Mailing Address - Fax:
Practice Address - Street 1:8115 MARKET ST STE 108
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8429
Practice Address - Country:US
Practice Address - Phone:910-332-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist