Provider Demographics
NPI:1487980587
Name:KENROY, KRISTEN RENEE (PT)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:RENEE
Last Name:KENROY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:RENEE
Other - Last Name:HEIMSOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12918 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4002
Mailing Address - Country:US
Mailing Address - Phone:210-372-9600
Mailing Address - Fax:210-372-9923
Practice Address - Street 1:615 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2355
Practice Address - Country:US
Practice Address - Phone:517-709-4677
Practice Address - Fax:517-798-5667
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist