Provider Demographics
NPI:1811960826
Name:MARDEN, KRISTEN
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:MARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BRIDGTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3653
Mailing Address - Country:US
Mailing Address - Phone:207-797-3477
Mailing Address - Fax:207-797-8577
Practice Address - Street 1:23 BRIDGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3653
Practice Address - Country:US
Practice Address - Phone:207-797-3477
Practice Address - Fax:207-797-8577
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04000035762251X0800X
MEPT2151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTMAVN3870Medicare ID - Type Unspecified