Provider Demographics
NPI:1821134214
Name:TIGNOR, KRISTEN MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:TIGNOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 CREEKWOOD BLVD.
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379
Mailing Address - Country:US
Mailing Address - Phone:636-528-7974
Mailing Address - Fax:
Practice Address - Street 1:1464 BOONE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2216
Practice Address - Country:US
Practice Address - Phone:636-528-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031151171W00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171W00000XOther Service ProvidersContractor
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist