Provider Demographics
NPI:1861157281
Name:OKUDA, KRISTEN EBERHARDT (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:EBERHARDT
Last Name:OKUDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARY
Other - Last Name:EBERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20820 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6000
Mailing Address - Country:US
Mailing Address - Phone:724-591-8121
Mailing Address - Fax:724-241-3625
Practice Address - Street 1:500 MARKET ST STE 103
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:724-728-7550
Practice Address - Fax:724-647-1570
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009931L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist