Provider Demographics
NPI:1679255822
Name:BALE, KRISTIAN WESLEY (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:WESLEY
Last Name:BALE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:KRISTIAN
Other - Middle Name:WESLEY
Other - Last Name:BALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:844 BURLEY BARN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-2107
Mailing Address - Country:US
Mailing Address - Phone:931-358-8533
Mailing Address - Fax:
Practice Address - Street 1:4583 GUTHRIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5422
Practice Address - Country:US
Practice Address - Phone:931-802-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16064225100000X
IN05015290A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist