Provider Demographics
NPI:1497991368
Name:WOLCOTT, KRISTIN MCCORKLE (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MCCORKLE
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHELLE
Other - Last Name:MCCORKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 NEWTON SPARTA RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2775
Mailing Address - Country:US
Mailing Address - Phone:973-940-8680
Mailing Address - Fax:973-383-1072
Practice Address - Street 1:280 NEWTON SPARTA RD UNIT B
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2775
Practice Address - Country:US
Practice Address - Phone:973-940-8680
Practice Address - Fax:973-383-1072
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029675-1225100000X
NJ40QA001455400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist