Provider Demographics
NPI:1023986734
Name:STOLLER, KRISTEN ROSE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ROSE
Last Name:STOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 OCEAN ST APT 1303
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-0116
Mailing Address - Country:US
Mailing Address - Phone:815-299-8598
Mailing Address - Fax:
Practice Address - Street 1:4540 OCEAN ST APT 1303
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-0116
Practice Address - Country:US
Practice Address - Phone:815-299-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06007012A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant