Provider Demographics
NPI:1962364992
Name:DEAN, KRISTTIN
Entity type:Individual
Prefix:
First Name:KRISTTIN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4926
Mailing Address - Country:US
Mailing Address - Phone:954-980-4336
Mailing Address - Fax:
Practice Address - Street 1:761 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-4926
Practice Address - Country:US
Practice Address - Phone:954-980-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL54032081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine