Provider Demographics
NPI:1831393149
Name:AGENA, KRISTEN MARTA (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARTA
Last Name:AGENA
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1041
Mailing Address - Country:US
Mailing Address - Phone:563-387-1658
Mailing Address - Fax:563-387-1228
Practice Address - Street 1:700 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1041
Practice Address - Country:US
Practice Address - Phone:563-387-1658
Practice Address - Fax:563-387-1228
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA003192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer