Provider Demographics
NPI:1790213510
Name:DICARNE, KRYSTEN MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:MARIE
Last Name:DICARNE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRYSTEN
Other - Middle Name:MARIE
Other - Last Name:CREIGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4704 OAK PKWY
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4704 OAK PKWY
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3349
Practice Address - Country:US
Practice Address - Phone:215-932-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist