1336734136 NPI number — KRISTEN VICTORIA TATE PHYSICAL THERAPIST

Table of content: KRISTEN VICTORIA TATE PHYSICAL THERAPIST (NPI 1336734136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336734136 NPI number — KRISTEN VICTORIA TATE PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATE
Provider First Name:
KRISTEN
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMILLEN
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
VICTORIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336734136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 INDUSTRIAL DR STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-389-7855
Provider Business Mailing Address Fax Number:
302-449-2047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 FOULK RD STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19803-3733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-407-3422
Provider Business Practice Location Address Fax Number:
877-407-4329
Provider Enumeration Date:
03/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  J1-0014326 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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