Provider Demographics
NPI:1649236944
Name:PHILLIPS, KRISTEN NOELLE (ATC, PTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NOELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3502
Mailing Address - Country:US
Mailing Address - Phone:740-755-0368
Mailing Address - Fax:
Practice Address - Street 1:2484 W STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5608
Practice Address - Country:US
Practice Address - Phone:330-829-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0013332083S0010X
OH07725225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine