Provider Demographics
NPI:1578689667
Name:CARMEN, KRISTIN S (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:CARMEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:S
Other - Last Name:FRANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:220 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3948
Mailing Address - Country:US
Mailing Address - Phone:440-213-2803
Mailing Address - Fax:
Practice Address - Street 1:220 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-3948
Practice Address - Country:US
Practice Address - Phone:440-213-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05484225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant