Healthcare Provider Details

I. General information

NPI: 1861157281
Provider Name (Legal Business Name): KRISTEN EBERHARDT OKUDA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MARY EBERHARDT PT

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST STE 103
BEAVER PA
15009-2998
US

IV. Provider business mailing address

20820 ROUTE 19
CRANBERRY TOWNSHIP PA
16066-6000
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-7550
  • Fax: 724-647-1570
Mailing address:
  • Phone: 724-591-8121
  • Fax: 724-241-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009931L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: