Provider Demographics
NPI:1134407893
Name:MURRAY, KRISTIN GATES (PTA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:GATES
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 FRIST BLVD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4839
Mailing Address - Country:US
Mailing Address - Phone:772-460-0088
Mailing Address - Fax:772-460-8555
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:SUITE#7
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-466-0088
Practice Address - Fax:772-460-8555
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19221225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant