Provider Demographics
NPI:1760524730
Name:RICHARDSON, KRISTEN KELLI (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN KELLI
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23372
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-3372
Mailing Address - Country:US
Mailing Address - Phone:406-672-7844
Mailing Address - Fax:
Practice Address - Street 1:801 14TH ST W STE B
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5364
Practice Address - Country:US
Practice Address - Phone:406-672-7844
Practice Address - Fax:406-248-8829
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000060203OtherBLUE CROSS & BLUE SHIELD