Provider Demographics
NPI:1265169585
Name:BURGESS, KRISTI (DPT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 STRATHBURN CT APT B
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2826
Mailing Address - Country:US
Mailing Address - Phone:518-763-7447
Mailing Address - Fax:
Practice Address - Street 1:1195 DRAKE MILL LN SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-8561
Practice Address - Country:US
Practice Address - Phone:704-251-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist