Provider Demographics
NPI:1881289742
Name:IHLE, KRISTEN CARRETE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CARRETE
Last Name:IHLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:CARRETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 GREENSPRING DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3114
Mailing Address - Country:US
Mailing Address - Phone:410-989-3833
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:10 N HAYS ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3650
Practice Address - Country:US
Practice Address - Phone:410-989-3833
Practice Address - Fax:410-793-4579
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist