Provider Demographics
NPI:1518454321
Name:WING, KRISTYN THACKER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:THACKER
Last Name:WING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTYN
Other - Middle Name:SHAYNE
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3947 GULF SHORES PKWY STE 260
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2729
Practice Address - Country:US
Practice Address - Phone:251-943-0803
Practice Address - Fax:251-943-4403
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist