Provider Demographics
NPI:1588999841
Name:DELPAINE, KRISTEN JALBERT (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JALBERT
Last Name:DELPAINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:JALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL RD.
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-372-7060
Mailing Address - Fax:781-372-7069
Practice Address - Street 1:16 HAYDEN AVE
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7929
Practice Address - Country:US
Practice Address - Phone:781-372-7060
Practice Address - Fax:781-372-7069
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083875AMedicaid
MA110083875AMedicaid