Provider Demographics
NPI:1982075917
Name:CARTER, KRISTIN (PTA, CLT-LANA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PTA, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 STATE HIGHWAY 198
Mailing Address - Street 2:
Mailing Address - City:CONNEAUTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16406-2646
Mailing Address - Country:US
Mailing Address - Phone:814-587-2012
Mailing Address - Fax:814-587-2530
Practice Address - Street 1:9108 STATE HIGHWAY 198
Practice Address - Street 2:
Practice Address - City:CONNEAUTVILLE
Practice Address - State:PA
Practice Address - Zip Code:16406-2646
Practice Address - Country:US
Practice Address - Phone:814-587-2012
Practice Address - Fax:814-587-2530
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003820225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant