Provider Demographics
NPI:1376556662
Name:HANKS, KRISTINE M (P T)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:HANKS
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:M
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12881 ELMFORD LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4720
Mailing Address - Country:US
Mailing Address - Phone:561-929-8175
Mailing Address - Fax:
Practice Address - Street 1:574 E MAIN ST
Practice Address - Street 2:C/O WORRELL THERAPY SERVICES
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348-3879
Practice Address - Country:US
Practice Address - Phone:276-773-8118
Practice Address - Fax:276-773-2219
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23058312992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA562209989OtherTAX ID