Provider Demographics
NPI:1104049386
Name:CARSON, KRISTI ABIGAIL (CMT)
Entity type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:ABIGAIL
Last Name:CARSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 COFFEE RD
Mailing Address - Street 2:STE. D-3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2427
Mailing Address - Country:US
Mailing Address - Phone:209-525-9133
Mailing Address - Fax:209-523-1495
Practice Address - Street 1:2020 COFFEE RD
Practice Address - Street 2:STE. D-3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2427
Practice Address - Country:US
Practice Address - Phone:209-525-9133
Practice Address - Fax:209-523-1495
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABG02263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist