Provider Demographics
NPI:1972953073
Name:KOROSCIL, KRISTEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KOROSCIL
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 1:392 SCHERTZ PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2073
Mailing Address - Country:US
Mailing Address - Phone:210-659-0222
Mailing Address - Fax:210-659-0012
Practice Address - Street 1:392 SCHERTZ PKWY
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2073
Practice Address - Country:US
Practice Address - Phone:210-659-0222
Practice Address - Fax:210-659-0012
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1273190225100000X
OH013796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist