Provider Demographics
NPI:1457450181
Name:SAILORS, KRISTIN MALLISSA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MALLISSA
Last Name:SAILORS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:MALLISSA
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2516 ROSALIND AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2326
Mailing Address - Country:US
Mailing Address - Phone:540-312-8015
Mailing Address - Fax:
Practice Address - Street 1:1995 S MAIN ST
Practice Address - Street 2:801
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6637
Practice Address - Country:US
Practice Address - Phone:540-951-2703
Practice Address - Fax:540-953-0873
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist