Provider Demographics
NPI:1215128855
Name:HAMILTON, KRISTIN E (PT, MSPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:E
Other - Last Name:ECHTERNACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MSPT
Mailing Address - Street 1:1400 BELLINGER ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5222
Mailing Address - Country:US
Mailing Address - Phone:715-838-5222
Mailing Address - Fax:
Practice Address - Street 1:1400 BELLINGER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5222
Practice Address - Country:US
Practice Address - Phone:715-838-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42090225100000X
WI6014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40312600Medicaid