Provider Demographics
NPI:1174700777
Name:TEARPOCK, KRISTIE MICHELLE (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:MICHELLE
Last Name:TEARPOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S ORLANDO AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:407-539-2953
Mailing Address - Fax:
Practice Address - Street 1:1400 S ORLANDO AVE STE 207
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:407-539-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686702Medicare UPIN