Provider Demographics
NPI:1407891492
Name:VOGELSANG, KRISTY MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:VOGELSANG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5701
Mailing Address - Country:US
Mailing Address - Phone:901-818-9746
Mailing Address - Fax:901-818-9741
Practice Address - Street 1:5039 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5701
Practice Address - Country:US
Practice Address - Phone:901-818-9746
Practice Address - Fax:901-818-9741
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA3567225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant