Provider Demographics
NPI:1336717651
Name:BROOKS, KRISTINA A (MED, LPATA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MED, LPATA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7984 NEW LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4718
Mailing Address - Country:US
Mailing Address - Phone:502-426-2777
Mailing Address - Fax:502-426-2776
Practice Address - Street 1:7984 NEW LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4718
Practice Address - Country:US
Practice Address - Phone:502-426-2777
Practice Address - Fax:502-426-2776
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271079221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist