Kristin Marie Provo, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

033003 Issued in NY

Practice address

Kidstart
5871 Groveland Station Rd
Mount Morris, NY 14510-9767

Phone

(585) 658-4023

Fax

(585) 658-4066

NPI assigned

Aug 19, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kristin Marie Bruce Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Livingston County

  • Community Based Hospice Care Agency
  • Mount Morris, NY
  • NPI 1326060724
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1275849895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KIDSTART",
            "address_2": "5871 GROVELAND STATION RD",
            "city": "MOUNT MORRIS",
            "state": "NY",
            "postal_code": "145109767",
            "telephone_number": "585-658-4023",
            "fax_number": "585-658-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "KIDSTART",
            "address_2": "5871 GROVELAND STATION RD",
            "city": "MOUNT MORRIS",
            "state": "NY",
            "postal_code": "145109767",
            "telephone_number": "585-658-4023",
            "fax_number": "585-658-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVO",
        "first_name": "KRISTIN",
        "middle_name": "MARIE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-19",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "BRUCE",
            "middle_name": "MARIE",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca Paul, MS, CCC-SLP/L
• Peggy Hamilton
• Amy Peraino
• Laura Marie Piche, CCC-SLP
• Gabriel Proulx, D.M.D.
• Tonia Lyn Prutsman, LPN
• Rite Aid of New York Inc
• Sonya Marie Roberts, A.S.
• Janet D Robinson, MA CCC-SLP
• Kathleen M Root, RN

• Physical Therapist in Mount Morris, NY
• Providers in Mount Morris, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.