Provider Demographics
NPI:1952786493
Name:BRISCOE, KRISTINA
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 BAYFIELD PKWY # 193
Mailing Address - Street 2:SUITE 193
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7597
Mailing Address - Country:US
Mailing Address - Phone:704-266-3531
Mailing Address - Fax:
Practice Address - Street 1:18809 W CATAWBA AVE # 204-E
Practice Address - Street 2:204-E
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5547
Practice Address - Country:US
Practice Address - Phone:704-266-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist