Provider Demographics
NPI:1649509621
Name:HALL, KRISTIN ERIN (PT MPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ERIN
Last Name:HALL
Suffix:
Gender:F
Credentials:PT MPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ERIN
Other - Last Name:DEATHERAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MPT
Mailing Address - Street 1:4545 LASATER TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1642
Mailing Address - Country:US
Mailing Address - Phone:714-654-1110
Mailing Address - Fax:
Practice Address - Street 1:930 LETA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1127
Practice Address - Country:US
Practice Address - Phone:714-654-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871020225100000X
CAPT29518225100000X
COPTL.0016885261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist