Healthcare Provider Details

I. General information

NPI: 1306985098
Provider Name (Legal Business Name): KRISTIN BRIEM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

053 MCKINLY LAB UNIVERSITY OF DELAWARE
NEWARK DE
19716-2590
US

IV. Provider business mailing address

609 ACADEMY ST
NEWARK DE
19711-5101
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-8893
  • Fax: 302-831-4468
Mailing address:
  • Phone: 302-831-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0001845
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: