Provider Demographics
NPI:1811007388
Name:MENDE, KRISTIN LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNN
Last Name:MENDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5906
Mailing Address - Country:US
Mailing Address - Phone:410-733-3030
Mailing Address - Fax:
Practice Address - Street 1:4801 DORSEY HALL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7766
Practice Address - Country:US
Practice Address - Phone:443-393-3788
Practice Address - Fax:443-378-3533
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist