=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033285580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN E FARMER-VONDERHEID MSPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 N 6TH ST
-----------------------------------------------------
City | SHAMOKIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17872-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-644-2353
-----------------------------------------------------
Fax | 570-644-2392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1086 HIGHWAY 315 BLVD
-----------------------------------------------------
City | WILKES BARRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18702-7012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-823-7761
-----------------------------------------------------
Fax | 570-822-8033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT012548L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------