Provider Demographics
NPI:1922249861
Name:VAIL, KRISTEN R N (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:R N
Last Name:VAIL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2886
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-0886
Mailing Address - Country:US
Mailing Address - Phone:808-685-8801
Mailing Address - Fax:
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:STE 210
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3609
Practice Address - Country:US
Practice Address - Phone:808-674-9262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist