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NPI Code Detail

MEDICARE: KRISTI MICHELLE MAUPIN ATC,DPT

MEDICARE: KRISTI MICHELLE MAUPIN ATC,DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305203998VA

General Provider Information

NPI Number : 1639135494
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTI MICHELLE MAUPIN ATC,DPT
Provider Business Mailing Address
First Line : PO BOX 877
Second Line :
City : BOWLING GREEN
State : VA
Zip : 22427-0877
Country : US
Telephone Number : 804-633-1232
Fax Number : 804-633-6032
Provider Business Practice Location Address
First Line : 121 COURTHOUSE LN
Second Line :
City : BOWLING GREEN
State : VA
Zip : 22427-9336
Country : US
Telephone Number : 804-633-1232
Fax Number : 804-633-6032
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2006
Last Update Date : 07/08/2007

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