Provider Demographics
NPI:1588696363
Name:HARVEY, KRISTIN (DPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:404 STATE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6623
Mailing Address - Country:US
Mailing Address - Phone:207-942-7630
Mailing Address - Fax:207-942-5686
Practice Address - Street 1:404 STATE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6623
Practice Address - Country:US
Practice Address - Phone:207-942-7630
Practice Address - Fax:207-942-5686
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432025799Medicaid
ME7092737OtherAETNA INDIVIDUAL PROVIDER ID
ME098634OtherANTHEM INDIVIDUAL PROVIDER ID
MEME1574Medicare PIN