Provider Demographics
NPI:1255315529
Name:HIETBRINK, KRISTIN MICHELLE (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:HIETBRINK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-4443
Mailing Address - Fax:704-316-4444
Practice Address - Street 1:11840 SOUTHMORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4466
Practice Address - Country:US
Practice Address - Phone:704-316-4443
Practice Address - Fax:704-316-4444
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079P8OtherBCBS
NC7905668OtherAETNA