Provider Demographics
NPI:1831775030
Name:CARTER, KRISTEN TANIA (LPTA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:TANIA
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8419
Mailing Address - Country:US
Mailing Address - Phone:601-394-9845
Mailing Address - Fax:
Practice Address - Street 1:680 BAY COVE DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-5551
Practice Address - Country:US
Practice Address - Phone:228-702-0142
Practice Address - Fax:228-396-3060
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA5801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist