Provider Demographics
NPI:1790866697
Name:ANDERSON, KRISTIN ELAINE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELAINE
Last Name:ANDERSON
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 1:45 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-5310
Mailing Address - Country:US
Mailing Address - Phone:401-765-0677
Mailing Address - Fax:
Practice Address - Street 1:501 GREAT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:401-767-2425
Practice Address - Fax:401-766-3674
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00168225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant