Provider Demographics
NPI:1649550278
Name:ADAMS, KRISTEN (PT)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:ADAMS
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 1:1704 LENA ST
Mailing Address - Street 2:STE A1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2002
Mailing Address - Country:US
Mailing Address - Phone:505-982-5868
Mailing Address - Fax:
Practice Address - Street 1:3303 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1456
Practice Address - Country:US
Practice Address - Phone:503-232-1000
Practice Address - Fax:503-232-1143
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist