Provider Demographics
NPI:1578893673
Name:BEDNARZ, KRISTIN R (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:BEDNARZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:R
Other - Last Name:ERNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:170 TAYLOR STATION RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4491
Mailing Address - Country:US
Mailing Address - Phone:614-545-7900
Mailing Address - Fax:614-545-7901
Practice Address - Street 1:170 TAYLOR STATION RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4491
Practice Address - Country:US
Practice Address - Phone:614-545-7900
Practice Address - Fax:614-545-7901
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012602225100000X
NY034150225100000X
MD24397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD369797Y5FMedicare PIN