Provider Demographics
NPI:1952016693
Name:HIRSCH, KRYSTYN KELLY (DPT)
Entity Type:Individual
Prefix:
First Name:KRYSTYN
Middle Name:KELLY
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 CENTENNIAL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2712
Mailing Address - Country:US
Mailing Address - Phone:262-930-4941
Mailing Address - Fax:
Practice Address - Street 1:5737 ERIE ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-1970
Practice Address - Country:US
Practice Address - Phone:262-639-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11036-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist