Healthcare Provider Details

I. General information

NPI: 1528091840
Provider Name (Legal Business Name): KRISTIN PLUMBY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARSHALL ST N SUITE 2
BENWOOD WV
26031-1041
US

IV. Provider business mailing address

100 MARSHALL ST N SUITE 2
BENWOOD WV
26031-1041
US

V. Phone/Fax

Practice location:
  • Phone: 304-218-2300
  • Fax: 304-218-2299
Mailing address:
  • Phone: 304-218-2300
  • Fax: 304-218-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 002618
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: