Provider Demographics
NPI:1598976177
Name:BRADSHAW, KRISTEN LOUISE (PTA)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:LOUISE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:HULTGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 GREAT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6833
Mailing Address - Country:US
Mailing Address - Phone:401-766-7246
Mailing Address - Fax:
Practice Address - Street 1:501 GREAT RD STE 107
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:401-766-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00626225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant