Provider Demographics
NPI:1568751758
Name:CLEVELAND, KRISTEN E (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:E
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1519 E LARK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7316
Mailing Address - Country:US
Mailing Address - Phone:417-881-3278
Mailing Address - Fax:417-881-2278
Practice Address - Street 1:1519 E LARK ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7316
Practice Address - Country:US
Practice Address - Phone:417-881-3278
Practice Address - Fax:417-881-2278
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist