Provider Demographics
NPI:1427568799
Name:MASSEY, KRISTIN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BRADFORD BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-4618
Mailing Address - Country:US
Mailing Address - Phone:615-683-3010
Mailing Address - Fax:615-683-3016
Practice Address - Street 1:123 WESTERN PLAZA WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821
Practice Address - Country:US
Practice Address - Phone:423-623-7777
Practice Address - Fax:423-623-0707
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12034225100000X
COPTL.0014951225100000X
VA2305211211225100000X
NE3799225100000X
IN05012933A225100000X
KY007245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist