Provider Demographics
NPI:1891739157
Name:FEDORKA, KRISTINE ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANNE
Last Name:FEDORKA
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 1:129 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4434
Mailing Address - Country:US
Mailing Address - Phone:828-258-8800
Mailing Address - Fax:828-281-7178
Practice Address - Street 1:800 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3528
Practice Address - Country:US
Practice Address - Phone:828-698-4318
Practice Address - Fax:828-692-9450
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NC8604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210646Medicaid
NC2502894Medicare ID - Type Unspecified