Provider Demographics
NPI:1710937057
Name:TAYLOR, KRISTEN FITZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:FITZ
Last Name:TAYLOR
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 1:3014 WINTERGARDEN DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6651
Mailing Address - Country:US
Mailing Address - Phone:360-236-1392
Mailing Address - Fax:
Practice Address - Street 1:4044 15TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6962
Practice Address - Country:US
Practice Address - Phone:360-456-5154
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist