Healthcare Provider Details

I. General information

NPI: 1558204834
Provider Name (Legal Business Name): KRISTIN MARCRUM LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DEAN DR
GARDENDALE AL
35071-2763
US

IV. Provider business mailing address

2701 STATE HIGHWAY 160
WARRIOR AL
35180-4664
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-8709
  • Fax:
Mailing address:
  • Phone: 205-914-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA8661
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: