Provider Demographics
NPI:1568702926
Name:BRILL, KRISTEN SUE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUE
Last Name:BRILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:SUE
Other - Last Name:ALBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6685 E 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7808
Mailing Address - Country:US
Mailing Address - Phone:219-663-6392
Mailing Address - Fax:
Practice Address - Street 1:6685 E 117TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7808
Practice Address - Country:US
Practice Address - Phone:219-663-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004208A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant