Provider Demographics
NPI:1508484718
Name:BACHMANN, MCKENNA KRISTINE (MS, ATC, CSCS, CISSN)
Entity Type:Individual
Prefix:MS
First Name:MCKENNA
Middle Name:KRISTINE
Last Name:BACHMANN
Suffix:
Gender:F
Credentials:MS, ATC, CSCS, CISSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MIDVALE TER
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6622
Mailing Address - Country:US
Mailing Address - Phone:772-480-8696
Mailing Address - Fax:
Practice Address - Street 1:MOODY AIR FORCE BASE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605
Practice Address - Country:US
Practice Address - Phone:772-480-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0035252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer