Provider Demographics
NPI:1679507735
Name:KLINGEN, KRISTEN M (MPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:KLINGEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:KEENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:146 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3313
Mailing Address - Country:US
Mailing Address - Phone:610-789-0114
Mailing Address - Fax:
Practice Address - Street 1:57 W EAGLE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2234
Practice Address - Country:US
Practice Address - Phone:610-789-9887
Practice Address - Fax:610-789-9883
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008457L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2331048000OtherPERSONAL CHOICE PROVIDER#
PA5620457OtherAETNA TRADITIONAL PROV. #
1654463OtherBC/BS PIN
PA2331048000OtherKEYSTONE PIN
PA1170988OtherAETNA HMO PROVIDER #
PA085172Q4GMedicare PIN