Healthcare Provider Details

I. General information

NPI: 1083345995
Provider Name (Legal Business Name): KRISTEN BANE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN VOGELBEIN PT

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12970 BOOKER T WASHINGTON HWY
HARDY VA
24101-3953
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-719-7350
  • Fax: 540-719-0019
Mailing address:
  • Phone: 540-224-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215041
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: