Provider Demographics
NPI:1447434436
Name:KOHLEY, KRISTIN DEANNE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DEANNE
Last Name:KOHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:DEANNE
Other - Last Name:KNUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1014 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7925
Mailing Address - Country:US
Mailing Address - Phone:817-641-8617
Mailing Address - Fax:817-641-8620
Practice Address - Street 1:1014 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7925
Practice Address - Country:US
Practice Address - Phone:817-641-8617
Practice Address - Fax:817-641-8620
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1147362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1913956 01Medicaid
TXP00473718OtherRAILROAD PIN
TX1913956 01Medicaid