Provider Demographics
NPI:1669582961
Name:SLAUGHTER, KRISTIN ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANNE
Last Name:SLAUGHTER
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 1:7410 PASITO AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1428
Mailing Address - Country:US
Mailing Address - Phone:909-948-3170
Mailing Address - Fax:
Practice Address - Street 1:7410 PASITO AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1428
Practice Address - Country:US
Practice Address - Phone:909-948-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist