Kristine K Bour – Physical Therapy Assistant

Key facts

NPI: 1114470127
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapy Assistant 225200000X
License: 6280 (TN)
Practice address: 29 Taylor Ave
205
Crossville, TN 38555-4527
Phone: (931) 456-5757
Fax: (931) 456-5533
NPI assigned: Jul 26, 2016
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Advanced Rehabilitation Center, PLLC Physical Therapist · Crossville, TN · NPI 1093982175

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
6280	TN	MD	Physical Therapy Assistant

Practice roles

Organization	Specialty	Status	New patients
Advanced Rehabilitation Center, PLLC		Past since May 2, 2018	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapy Assistant	225200000X	6280	TN	Yes

Addresses

Primary practice location

29 Taylor Ave
205
Crossville, TN 38555-4527

Mailing address

29 Taylor Ave
205
Crossville, TN 38555-4527
Phone (931) 456-5757

Other identifiers

Identifier	Type	State	Issuer
6280	Other	TN	STATE LICENSE

Other providers in Crossville, TN

All providers in Crossville, TN · Physical Therapy Assistant in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.