Provider Demographics
NPI:1972523546
Name:WHITCOMB, KRISTI OVERSTREET (PT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:OVERSTREET
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2254
Mailing Address - Country:US
Mailing Address - Phone:252-443-0808
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:1501 N BICKETT BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2178
Practice Address - Country:US
Practice Address - Phone:919-497-8414
Practice Address - Fax:919-497-8478
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC068EVOtherBCBS
NC068EVOtherBCBS