Provider Demographics
NPI:1851691786
Name:BURGESS, KRISTINA R (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:R
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:R
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3552 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1639
Mailing Address - Country:US
Mailing Address - Phone:304-733-9560
Mailing Address - Fax:304-733-1141
Practice Address - Street 1:3552 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1639
Practice Address - Country:US
Practice Address - Phone:304-733-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT 002686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist