Provider Demographics
NPI:1669626966
Name:MCBRIDE, KRISTA M (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BROWNSBORO PARK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-7201
Mailing Address - Country:US
Mailing Address - Phone:502-855-2489
Mailing Address - Fax:502-895-7716
Practice Address - Street 1:6000 BROWNSBORO PARK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-7201
Practice Address - Country:US
Practice Address - Phone:502-855-2489
Practice Address - Fax:502-895-7716
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-0039432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPT-003943OtherSTATE LICENSE
KY1282019Medicare PIN