Provider Demographics
NPI:1760821136
Name:ELGIN, KRISTINE M (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:ELGIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:ELGIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:117 E WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BROADUS
Mailing Address - State:MT
Mailing Address - Zip Code:59317-7525
Mailing Address - Country:US
Mailing Address - Phone:406-436-2110
Mailing Address - Fax:949-655-7819
Practice Address - Street 1:117 E WILSON ST
Practice Address - Street 2:
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317-7525
Practice Address - Country:US
Practice Address - Phone:406-436-2646
Practice Address - Fax:406-436-2923
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist