Provider Demographics
NPI:1275671398
Name:CORN, KRISTINE N (PT, MSPTDPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:N
Last Name:CORN
Suffix:
Gender:F
Credentials:PT, MSPTDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8485 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9356
Mailing Address - Country:US
Mailing Address - Phone:916-791-2747
Mailing Address - Fax:916-791-2189
Practice Address - Street 1:8485 BARTON RD
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-9356
Practice Address - Country:US
Practice Address - Phone:916-791-2747
Practice Address - Fax:916-791-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 684208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation