Provider Demographics
NPI:1265544431
Name:WEST, KRISTIN M (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:WEST
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 1:106 MILFORD ST STE 601
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6938
Mailing Address - Country:US
Mailing Address - Phone:410-548-7600
Mailing Address - Fax:410-548-2651
Practice Address - Street 1:106 MILFORD ST STE 601
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6938
Practice Address - Country:US
Practice Address - Phone:410-548-7600
Practice Address - Fax:410-548-2651
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409809900Medicaid
MD65120901OtherBCBS
MD409809900Medicaid
MDQ66206Medicare UPIN