Provider Demographics
NPI:1760662498
Name:VEACH, KRISTINA (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:VEACH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 POPPY DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-7955
Mailing Address - Country:US
Mailing Address - Phone:606-836-0606
Mailing Address - Fax:606-836-0612
Practice Address - Street 1:70 POPPY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-7955
Practice Address - Country:US
Practice Address - Phone:606-836-0606
Practice Address - Fax:606-836-0612
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01585225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant