Provider Demographics
NPI:1194987149
Name:PETERSON, KRISTINE R (PT)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:R
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:R
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2900 12TH AVE N STE 140W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7507
Mailing Address - Country:US
Mailing Address - Phone:406-237-5050
Mailing Address - Fax:406-238-6599
Practice Address - Street 1:1323 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1741
Practice Address - Country:US
Practice Address - Phone:406-896-1397
Practice Address - Fax:406-896-1711
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2150PT225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2150PTOtherLICENSE