Provider Demographics
NPI:1013111715
Name:VERNON, KRISTIN RHINEHART (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:RHINEHART
Last Name:VERNON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-8537
Mailing Address - Country:US
Mailing Address - Phone:704-675-5715
Mailing Address - Fax:
Practice Address - Street 1:2300 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0613
Practice Address - Country:US
Practice Address - Phone:704-834-3037
Practice Address - Fax:704-834-3038
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2731225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant