Provider Demographics
NPI:1063105716
Name:WEBB, KIRSTIN MARIE (PTA)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MARIE
Last Name:WEBB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HIDDEN COVE STREET
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1027
Mailing Address - Country:US
Mailing Address - Phone:419-345-4685
Mailing Address - Fax:
Practice Address - Street 1:600 RODEO DR
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1279
Practice Address - Country:US
Practice Address - Phone:859-905-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04429225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant