Provider Demographics
NPI:1609104363
Name:BEVERS, KRISTIN (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:BEVERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:UPTMOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:610 WHITETAIL DR
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8593
Mailing Address - Country:US
Mailing Address - Phone:208-720-3480
Mailing Address - Fax:
Practice Address - Street 1:1450 AVIATION DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8767
Practice Address - Country:US
Practice Address - Phone:208-727-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist