Provider Demographics
NPI:1154622918
Name:BRENTS, KRISTEN MARIE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:BRENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:287 STEWARTS LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-7360
Mailing Address - Country:US
Mailing Address - Phone:502-689-6188
Mailing Address - Fax:
Practice Address - Street 1:287 STEWARTS LN
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-7360
Practice Address - Country:US
Practice Address - Phone:502-689-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist