Provider Demographics
NPI:1821027350
Name:BURRIS, KRISTEN CATHLEEN (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:CATHLEEN
Last Name:BURRIS
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 FAST LANDING RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3107
Mailing Address - Country:US
Mailing Address - Phone:302-632-7152
Mailing Address - Fax:302-697-4536
Practice Address - Street 1:823 WALNUT SHADE RD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:DE
Practice Address - Zip Code:19980
Practice Address - Country:US
Practice Address - Phone:302-697-3255
Practice Address - Fax:302-697-4536
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00001472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer