Provider Demographics
NPI:1841274461
Name:WOOD, KRISTEN RAE (PT)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:RAE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 CREEK CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3014
Mailing Address - Country:US
Mailing Address - Phone:406-721-0775
Mailing Address - Fax:406-542-3672
Practice Address - Street 1:715 KENSINGTON AVE
Practice Address - Street 2:STE. 18
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5769
Practice Address - Country:US
Practice Address - Phone:406-542-3600
Practice Address - Fax:406-542-3672
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000349384Medicaid