Provider Demographics
NPI:1356547087
Name:WEEMS, KRISTY A (PT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:A
Last Name:WEEMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-3530
Mailing Address - Country:US
Mailing Address - Phone:912-384-2200
Mailing Address - Fax:912-383-7992
Practice Address - Street 1:310 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2332
Practice Address - Country:US
Practice Address - Phone:912-260-3650
Practice Address - Fax:912-383-7361
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006086OtherPHYSICAL THERAPIST STATE