Provider Demographics
NPI:1326056334
Name:CARTER, KRISTINA M (PT, DPT, CMTPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT, DPT, CMTPT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-373-2919
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:4125 IRONBOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2666
Practice Address - Country:US
Practice Address - Phone:757-220-8383
Practice Address - Fax:757-253-7833
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204679225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010294029Medicaid
VAP00361686OtherMEDICARE RAILROAD
VA192935OtherBCBS PHYSICAL THERAPY
VA7879840OtherAETNA
VA192935OtherBCBS PHYSICAL THERAPY
VAP00361686OtherMEDICARE RAILROAD