Basic Information
| Provider Information | |||||||||
| NPI: | 1972523546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITCOMB | ||||||||
| FirstName: | KRISTI | ||||||||
| MiddleName: | OVERSTREET | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2413 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY MT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524430808 | ||||||||
| FaxNumber: | 2524519032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N BICKETT BLVD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | LOUISBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275492178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194978414 | ||||||||
| FaxNumber: | 9194978478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 12/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2255 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 068EV | 01 | NC | BCBS | OTHER |