Basic Information
| Provider Information | |||||||||
| NPI: | 1932124609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAXTER | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 650 TEN ROD ROAD | ||||||||
| Address2: | MAILBOX #10 | ||||||||
| City: | N. KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016677997 | ||||||||
| FaxNumber: | 4016677998 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 TEN ROD RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | NORTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028524238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016677997 | ||||||||
| FaxNumber: | 4016677998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT00793 | RI | N | Other Service Providers | Specialist | 2251H1200X | PT00793 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
No ID Information.