Provider Demographics
NPI:1740653435
Name:MONGAN, KRISTINE BEDELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:BEDELL
Last Name:MONGAN
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:BEDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4905 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2315
Mailing Address - Country:US
Mailing Address - Phone:865-689-8299
Mailing Address - Fax:865-689-9804
Practice Address - Street 1:4905 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2315
Practice Address - Country:US
Practice Address - Phone:865-689-8299
Practice Address - Fax:865-689-9804
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist