Provider Demographics
NPI:1043994569
Name:TRIQUET, KRISTEN MACKIE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MACKIE
Last Name:TRIQUET
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:MACKIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:461 POND APPLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2208
Mailing Address - Country:US
Mailing Address - Phone:978-417-1834
Mailing Address - Fax:
Practice Address - Street 1:2930 S MERIDIAN STE 120
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1654
Practice Address - Country:US
Practice Address - Phone:253-445-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16329225100000X
WAPT61443440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist