Healthcare Provider Details

I. General information

NPI: 1043919251
Provider Name (Legal Business Name): KRISTEN MARIE OBERHOLZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 STOUFFER AVE
CHAMBERSBURG PA
17201-2938
US

IV. Provider business mailing address

11796 STULL RD
GREENCASTLE PA
17225-9112
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-0436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE008162
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: