Healthcare Provider Details

I. General information

NPI: 1649509621
Provider Name (Legal Business Name): KRISTIN ERIN HALL PT MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN ERIN DEATHERAGE PT MPT

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 LETA DR
COLORADO SPRINGS CO
80911-1127
US

IV. Provider business mailing address

4545 LASATER TRL
COLORADO SPRINGS CO
80922-1642
US

V. Phone/Fax

Practice location:
  • Phone: 714-654-1110
  • Fax:
Mailing address:
  • Phone: 714-654-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT871020
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29518
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTL.0016885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: