Provider Demographics
NPI:1801991807
Name:GRAINGER, KRISTEN S (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:S
Last Name:GRAINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:S
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3001 EDWARDS MILL RD
Mailing Address - Street 2:# 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5243
Mailing Address - Country:US
Mailing Address - Phone:919-863-6872
Mailing Address - Fax:919-781-5246
Practice Address - Street 1:3320 EXECUTIVE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-872-3747
Practice Address - Fax:919-872-3414
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC192066OtherMEDCOST
NC068AWOtherBCBSNC
NC2509448Medicare PIN