Provider Demographics
NPI:1518665991
Name:BURNS, KRISTEN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 SW REGENCY PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7488
Mailing Address - Country:US
Mailing Address - Phone:479-252-3321
Mailing Address - Fax:479-668-2257
Practice Address - Street 1:3201 SW REGENCY PKWY STE 5
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7488
Practice Address - Country:US
Practice Address - Phone:479-252-3321
Practice Address - Fax:479-668-2257
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist