Provider Demographics
NPI:1659056299
Name:DAVIDSON, KRISTEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21711 CAROUSEL DR
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5362
Mailing Address - Country:US
Mailing Address - Phone:479-957-8080
Mailing Address - Fax:
Practice Address - Street 1:1675 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3057
Practice Address - Country:US
Practice Address - Phone:479-524-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist