Provider Demographics
NPI:1528210630
Name:BEEBE, KRISTINE ANN (P T)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:BEEBE
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ANN
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:P T
Mailing Address - Street 1:44 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4390
Mailing Address - Country:US
Mailing Address - Phone:941-504-7474
Mailing Address - Fax:
Practice Address - Street 1:44 ESSEX RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4390
Practice Address - Country:US
Practice Address - Phone:941-504-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 24308225100000X
CAPT 22516225100000X
MA20359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist