Provider Demographics
NPI:1639135494
Name:MAUPIN, KRISTI MICHELLE (ATC,DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MICHELLE
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:ATC,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-0877
Mailing Address - Country:US
Mailing Address - Phone:804-633-1232
Mailing Address - Fax:804-633-6032
Practice Address - Street 1:121 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-9336
Practice Address - Country:US
Practice Address - Phone:804-633-1232
Practice Address - Fax:804-633-6032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist