Provider Demographics
NPI:1699985135
Name:PROTZMAN, KRISTINA OPAL (PTA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:OPAL
Last Name:PROTZMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 EMPSON DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-5278
Mailing Address - Country:US
Mailing Address - Phone:615-643-8270
Mailing Address - Fax:
Practice Address - Street 1:124 EMPSON DR
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:TN
Practice Address - Zip Code:37073-5278
Practice Address - Country:US
Practice Address - Phone:615-643-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004203225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant