Provider Demographics
NPI:1831555820
Name:TOMBLIN, KRISTA (DPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:TOMBLIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 BLUFFTON PKWY APT 1025
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4674
Mailing Address - Country:US
Mailing Address - Phone:716-969-5121
Mailing Address - Fax:
Practice Address - Street 1:811 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3442
Practice Address - Country:US
Practice Address - Phone:843-338-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8007225100000X
NY039704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist