Provider Demographics
NPI:1043644578
Name:CALLARD, KRISTIN MARIE (PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:CALLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:107 5TH ST SE
Mailing Address - Street 2:#7
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4269
Mailing Address - Country:US
Mailing Address - Phone:330-753-7400
Mailing Address - Fax:
Practice Address - Street 1:107 5TH ST SE
Practice Address - Street 2:#7
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4269
Practice Address - Country:US
Practice Address - Phone:330-753-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT. 012513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist