Provider Demographics
NPI:1235654773
Name:BROCKETT, KRISTINA (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BROCKETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 62ND CT SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8009
Mailing Address - Country:US
Mailing Address - Phone:253-876-5235
Mailing Address - Fax:
Practice Address - Street 1:1812 62ND CT SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8009
Practice Address - Country:US
Practice Address - Phone:253-876-5235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer