Provider Demographics
NPI:1730398348
Name:SIEGEL, KRISTIN M (PT)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 RAINBOW DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2131
Mailing Address - Country:US
Mailing Address - Phone:215-990-9586
Mailing Address - Fax:
Practice Address - Street 1:1900 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2304
Practice Address - Country:US
Practice Address - Phone:215-990-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist