Provider Demographics
NPI:1588605513
Name:WALDECK, KRISTY L (MSPT)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:L
Last Name:WALDECK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 JOURNEYS END TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2385
Mailing Address - Country:US
Mailing Address - Phone:330-687-0231
Mailing Address - Fax:
Practice Address - Street 1:114 WELTON WAY
Practice Address - Street 2:STE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9163
Practice Address - Country:US
Practice Address - Phone:704-660-6551
Practice Address - Fax:704-660-9894
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist