Provider Demographics
NPI:1720032584
Name:COHEN, KRISTIN D (RPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:COHEN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-294-6734
Practice Address - Street 1:3 LIESL LN
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3036
Practice Address - Country:US
Practice Address - Phone:203-483-2516
Practice Address - Fax:203-466-8527
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6621225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080006621CT07OtherANTHEM BCBS