Provider Demographics
NPI:1831714054
Name:TROWBRIDGE, KRISTIN LYNN (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNN
Last Name:TROWBRIDGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MAIN RD NW
Mailing Address - Street 2:
Mailing Address - City:DEPAUW
Mailing Address - State:IN
Mailing Address - Zip Code:47115-9056
Mailing Address - Country:US
Mailing Address - Phone:812-968-4584
Mailing Address - Fax:
Practice Address - Street 1:1300 N OLD HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2022
Practice Address - Country:US
Practice Address - Phone:812-734-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21906961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist