Provider Demographics
NPI:1881903565
Name:DYCK, KRISTEN A (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:DYCK
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 1:221 RUE DE JEAN
Mailing Address - Street 2:SUITE 126
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8501
Mailing Address - Country:US
Mailing Address - Phone:337-233-0322
Mailing Address - Fax:337-233-0225
Practice Address - Street 1:221 RUE DE JEAN
Practice Address - Street 2:SUITE 126
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8501
Practice Address - Country:US
Practice Address - Phone:337-233-0322
Practice Address - Fax:337-233-0225
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA07804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist