Provider Demographics
NPI:1336734136
Name:TATE, KRISTEN VICTORIA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:VICTORIA
Last Name:TATE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:VICTORIA
Other - Last Name:MCMILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1050 INDUSTRIAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2803
Mailing Address - Country:US
Mailing Address - Phone:302-389-7855
Mailing Address - Fax:302-449-2047
Practice Address - Street 1:100 S MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1495
Practice Address - Country:US
Practice Address - Phone:302-389-7855
Practice Address - Fax:302-449-2047
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist