Provider Demographics
NPI:1932124609
Name:BAXTER, KRISTEN J (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:J
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 TEN ROD ROAD
Mailing Address - Street 2:MAILBOX #10
Mailing Address - City:N. KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-667-7997
Mailing Address - Fax:401-667-7998
Practice Address - Street 1:650 TEN ROD RD
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4238
Practice Address - Country:US
Practice Address - Phone:401-667-7997
Practice Address - Fax:401-667-7998
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00793174400000X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007009521Medicare ID - Type Unspecified