Provider Demographics
NPI:1427290790
Name:CARLSON, KRISTEN (MSPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 WILMONT DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7117
Mailing Address - Country:US
Mailing Address - Phone:407-929-0472
Mailing Address - Fax:
Practice Address - Street 1:203 OLD CHAPIN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2017
Practice Address - Country:US
Practice Address - Phone:803-996-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24302225100000X
SC6719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist