Provider Demographics
NPI:1083179162
Name:GRIFFIN, KRISTAN LEAR-MARIE (ATC)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:LEAR-MARIE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 W MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2442
Mailing Address - Country:US
Mailing Address - Phone:505-452-7273
Mailing Address - Fax:
Practice Address - Street 1:1 W FIRESTORM WAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3216
Practice Address - Country:US
Practice Address - Phone:480-944-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program