Basic Information
Provider Information | |||||||||
NPI: | 1104025477 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROBBINS | ||||||||
FirstName: | KRISTAL | ||||||||
MiddleName: | R | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SWAFFORD | ||||||||
OtherFirstName: | KRISTAL | ||||||||
OtherMiddleName: | R | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DPT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 8823 PRODUCTION LN | ||||||||
Address2: |   | ||||||||
City: | OOLTEWAH | ||||||||
State: | TN | ||||||||
PostalCode: | 373636511 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4232388930 | ||||||||
FaxNumber: | 4232856647 | ||||||||
Practice Location | |||||||||
Address1: | 8904 CROSS PARK DR | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379234703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8656902671 | ||||||||
FaxNumber: | 8656906445 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/16/2007 | ||||||||
LastUpdateDate: | 09/02/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7878 | TN | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 4160129 | 01 | TN | BCBS | OTHER | CH4394 | 01 | TN | MEDICARE-RAILROAD GROUP ID | OTHER |