Provider Demographics
NPI:1568892420
Name:CARR, KRISTIN NICOLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:CARR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 KEOKUK WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:IA
Mailing Address - Zip Code:52248-9200
Mailing Address - Country:US
Mailing Address - Phone:319-461-1233
Mailing Address - Fax:
Practice Address - Street 1:2000 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-9572
Practice Address - Country:US
Practice Address - Phone:641-469-4353
Practice Address - Fax:641-469-4288
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005078225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant