Provider Demographics
NPI:1184610842
Name:ANDERSON, KRISTIE LEIGH (PT)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEIGH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0729
Mailing Address - Country:US
Mailing Address - Phone:334-793-2663
Mailing Address - Fax:334-836-2247
Practice Address - Street 1:345 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2053
Practice Address - Country:US
Practice Address - Phone:334-836-4523
Practice Address - Fax:334-673-0599
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121685Medicaid
AL511-09121OtherBCBS OF ALABAMA
AL511-09121OtherBCBS OF ALABAMA
ALQ46133Medicare UPIN