Provider Demographics
NPI:1952505661
Name:TENHOLDER, KRISTEN P (PT)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:P
Last Name:TENHOLDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:PATRICIA
Other - Last Name:WARGIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:631 BELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3603
Mailing Address - Country:US
Mailing Address - Phone:314-913-3597
Mailing Address - Fax:
Practice Address - Street 1:790 N HWY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5108
Practice Address - Country:US
Practice Address - Phone:314-972-1442
Practice Address - Fax:314-972-1533
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991511001Medicare PIN
223561654Medicare PIN
MO991509001Medicare PIN