Provider Demographics
NPI:1902295447
Name:ROSE, KRISTEN ABBETT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ABBETT
Last Name:ROSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:FRANCES
Other - Last Name:ABBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:111 WESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5021
Mailing Address - Country:US
Mailing Address - Phone:607-725-4769
Mailing Address - Fax:
Practice Address - Street 1:2215 E EGBERT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2590
Practice Address - Country:US
Practice Address - Phone:607-725-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012426225100000X
WAPT60272351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist