Provider Demographics
NPI:1619164076
Name:SPANN, KRISTIN MICHELLE (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:SPANN
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 1:28 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3487
Mailing Address - Country:US
Mailing Address - Phone:631-265-0670
Mailing Address - Fax:
Practice Address - Street 1:28 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3487
Practice Address - Country:US
Practice Address - Phone:631-265-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist