Healthcare Provider Details

I. General information

NPI: 1770468118
Provider Name (Legal Business Name): KRISTEN JULIANNA SPEAREN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 COUNTRY CLUB RD
FAIRMONT WV
26554-1306
US

IV. Provider business mailing address

2075 PINECREST DR
MORGANTOWN WV
26505-8039
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-2273
  • Fax:
Mailing address:
  • Phone: 304-672-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004907
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: