Provider Demographics
NPI:1669717351
Name:QUAGHEBEUR, KRISTINE (PT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:QUAGHEBEUR
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 1:597 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:UVALDA
Mailing Address - State:GA
Mailing Address - Zip Code:30473-4138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:597 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:UVALDA
Practice Address - State:GA
Practice Address - Zip Code:30473-4138
Practice Address - Country:US
Practice Address - Phone:706-410-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist