Individual
KRISTIN CHARLESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
414 S WESLEY AVE, MOUNT MORRIS, IL 61054-1428
(815) 734-4103
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.007379
IL
Other
Enumeration date
12/18/2019
Last updated
12/18/2019
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