Provider Demographics
NPI:1578544540
Name:WARREN, KRISTEN L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:WARREN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNNE
Other - Last Name:KIRKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10631 S 51ST ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5225
Mailing Address - Country:US
Mailing Address - Phone:602-380-7047
Mailing Address - Fax:
Practice Address - Street 1:1370 E ORCHID LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4320
Practice Address - Country:US
Practice Address - Phone:602-380-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79354Medicare PIN
AZ112384Medicare PIN
AZZ102616Medicare PIN
AZ117109Medicare PIN