Provider Demographics
NPI:1336810621
Name:CLEGG, KRISTIN (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CLEGG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7940
Mailing Address - Country:US
Mailing Address - Phone:407-342-5345
Mailing Address - Fax:
Practice Address - Street 1:2521 FAIRWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2712
Practice Address - Country:US
Practice Address - Phone:614-237-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics