Provider Demographics
NPI:1699333955
Name:ATCHISON, KIRSTEN (DPT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:ATCHISON
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 1:428 CEDAR GLEN DR APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6212
Mailing Address - Country:US
Mailing Address - Phone:260-241-8932
Mailing Address - Fax:
Practice Address - Street 1:12722 TONKEL RD STE 102
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8201
Practice Address - Country:US
Practice Address - Phone:269-739-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013346A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300032651Medicaid
IN05013346AOtherLICENSE