Provider Demographics
NPI:1811313687
Name:GIRSHIN, KRISTIN GRACE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:GRACE
Last Name:GIRSHIN
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 1:659 E 15TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2333
Mailing Address - Country:US
Mailing Address - Phone:845-701-1032
Mailing Address - Fax:
Practice Address - Street 1:659 E 15TH ST STE D
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2333
Practice Address - Country:US
Practice Address - Phone:909-493-1000
Practice Address - Fax:909-325-7895
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037-424225100000X
CA297398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist