Provider Demographics
NPI:1215747498
Name:EDWARDS, KRISTIN (ATC-L)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KENNER ARMY HEALTH CLINIC
Mailing Address - Street 2:700 24TH ST
Mailing Address - City:FT GREGG ADAMS
Mailing Address - State:VA
Mailing Address - Zip Code:23801
Mailing Address - Country:US
Mailing Address - Phone:804-734-5300
Mailing Address - Fax:877-874-1008
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FT GREGGADAMS
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-5300
Practice Address - Fax:877-874-1008
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
VA0702021282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty