Provider Demographics
NPI:1962217638
Name:MCCLOSKEY, KRISTEN (PT,DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 KINGSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-5034
Mailing Address - Country:US
Mailing Address - Phone:609-969-9339
Mailing Address - Fax:
Practice Address - Street 1:1509 ROUTE 38 STE 8
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2981
Practice Address - Country:US
Practice Address - Phone:609-784-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02316900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist