Basic Information
| Provider Information | |||||||||
| NPI: | 1568694743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAPLER | ||||||||
| FirstName: | CRISTIN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAVIS | ||||||||
| OtherFirstName: | CRISTIN | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 614 WESTPORT RD STE A | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427013832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703609129 | ||||||||
| FaxNumber: | 2702348197 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | BRANDENBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401081317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704225004 | ||||||||
| FaxNumber: | 2704225002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 7803 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 1243843 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2251X0800X | 18725 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 007803 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.