MEDICARE: KRISTEN JEAN DEMERS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1168882	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T8732	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1316051709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN JEAN DEMERS PT

Provider Business Mailing Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	BLDG 1, STE 102
City	:	AUSTIN
State	:	TX
Zip	:	78745-5281
Country	:	US
Telephone Number	:	512-651-0301
Fax Number	:	512-651-0305

Provider Business Practice Location Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	BLDG 1, STE 102
City	:	AUSTIN
State	:	TX
Zip	:	78745-5281
Country	:	US
Telephone Number	:	512-651-0301
Fax Number	:	512-651-0305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	10/17/2008

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Directions to “ KRISTEN JEAN DEMERS PT” Practice Location

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