Provider Demographics
NPI:1467810333
Name:SHIVERS, KRISTEN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:SHIVERS
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 1:209 RIVERWIND EAST, SUITE B
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208
Mailing Address - Country:US
Mailing Address - Phone:601-278-7036
Mailing Address - Fax:601-510-9500
Practice Address - Street 1:209 B RIVERWIND EAST
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208
Practice Address - Country:US
Practice Address - Phone:601-383-1247
Practice Address - Fax:601-510-9500
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist