Provider Demographics
NPI:1083868921
Name:HYER, KRISTEN J (MS, ATC, CSCS)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:J
Last Name:HYER
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N PARK ST
Mailing Address - Street 2:REAR APT
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2127
Mailing Address - Country:US
Mailing Address - Phone:607-423-4893
Mailing Address - Fax:
Practice Address - Street 1:6620 FLY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9717
Practice Address - Country:US
Practice Address - Phone:315-464-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001714-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer