Provider Demographics
NPI:1538416011
Name:CARLSON, KRISTIN MICHELLE (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:CARLSON
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 1:605 SOMBRERO BEACH RD
Mailing Address - Street 2:APT 303
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3958
Mailing Address - Country:US
Mailing Address - Phone:708-269-2163
Mailing Address - Fax:
Practice Address - Street 1:13365 OVERSEAS HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3513
Practice Address - Country:US
Practice Address - Phone:305-289-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist