Provider Demographics
NPI:1992016729
Name:HARVEY, KRISTEN A (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:A
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PIERPONT CENTER
Mailing Address - Street 2:1543 COUNTRY CLUB RD.
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-363-2273
Mailing Address - Fax:
Practice Address - Street 1:529 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1824
Practice Address - Country:US
Practice Address - Phone:304-842-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2023-02-22
Deactivation Date:2021-10-12
Deactivation Code:
Reactivation Date:2023-02-22
Provider Licenses
StateLicense IDTaxonomies
WV2008-2443225700000X
WVPTA002120225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist