Provider Demographics
NPI:1558730655
Name:HUMPHRIES, KRISTEN TARANTO (PT, DPT, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:TARANTO
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:PT, DPT, ATC, LAT
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:MARY
Other - Last Name:TARANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:1777 W SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2687
Mailing Address - Country:US
Mailing Address - Phone:520-884-9819
Mailing Address - Fax:520-884-0175
Practice Address - Street 1:1880 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1129
Practice Address - Country:US
Practice Address - Phone:520-884-9819
Practice Address - Fax:520-884-0175
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10971225100000X
FLAL37522255A2300X
AZLPT30388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer