Provider Demographics
NPI:1194495887
Name:NORTHRUP, KRISTEN MARIE (PTA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:NORTHRUP
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 1:709 CONKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-2766
Mailing Address - Country:US
Mailing Address - Phone:607-237-0148
Mailing Address - Fax:607-697-2035
Practice Address - Street 1:709 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-2766
Practice Address - Country:US
Practice Address - Phone:607-237-0148
Practice Address - Fax:607-697-2035
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant