Healthcare Provider Details

I. General information

NPI: 1376556662
Provider Name (Legal Business Name): KRISTINE M HANKS P. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE M HAMPTON PT

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 E MAIN ST C/O WORRELL THERAPY SERVICES
INDEPENDENCE VA
24348-3879
US

IV. Provider business mailing address

12881 ELMFORD LN
BOCA RATON FL
33428-4720
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-8118
  • Fax: 276-773-2219
Mailing address:
  • Phone: 561-929-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305831299
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: