Provider Demographics
NPI:1922488337
Name:HERNANDEZ, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:CALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:425 MOOSENECK RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:ME
Mailing Address - Zip Code:04606-3549
Mailing Address - Country:US
Mailing Address - Phone:571-296-9066
Mailing Address - Fax:
Practice Address - Street 1:425 MOOSENECK RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:ME
Practice Address - Zip Code:04606-3549
Practice Address - Country:US
Practice Address - Phone:571-296-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist