Provider Demographics
NPI:1942221536
Name:EARL, KRISTEN LEE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:EARL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:32 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3454
Mailing Address - Country:US
Mailing Address - Phone:304-733-9193
Mailing Address - Fax:
Practice Address - Street 1:4120 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1127
Practice Address - Country:US
Practice Address - Phone:304-429-7381
Practice Address - Fax:304-429-7383
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002216225100000X
KY004573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist