Provider Demographics
NPI:1346528817
Name:WILSON, KRISTEN ELIZABETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 WILMINGTON PIKE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-8122
Mailing Address - Country:US
Mailing Address - Phone:484-841-6154
Mailing Address - Fax:
Practice Address - Street 1:1786 WILMINGTON PIKE
Practice Address - Street 2:SUITE 100A
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-8122
Practice Address - Country:US
Practice Address - Phone:484-841-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist