Healthcare Provider Details

I. General information

NPI: 1598088205
Provider Name (Legal Business Name): KRISTEN K WORKMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5790 DENLINGER RD
DAYTON OH
45426-1838
US

IV. Provider business mailing address

5790 DENLINGER RD
DAYTON OH
45426-1838
US

V. Phone/Fax

Practice location:
  • Phone: 937-837-5581
  • Fax:
Mailing address:
  • Phone: 937-837-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 07055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: