| NPI | 1649509621 |
|---|---|
| Former Name | KRISTIN ERIN DEATHERAGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: CO PTL.0016885) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT871020) |
| 225100000X Physical Therapist (Licence: CA pt29518) | |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2023-10-23 |