Basic Information
| Provider Information | |||||||||
| NPI: | 1609863695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLEIDER-ZOPH | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10321 CHAMPION FARMS DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402416129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028999363 | ||||||||
| FaxNumber: | 5028999365 | ||||||||
| Practice Location | |||||||||
| Address1: | 10321 CHAMPION FARMS DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402416129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028999363 | ||||||||
| FaxNumber: | 5028999365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 05/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 002226 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000000354852 | 01 | ANTHEM | OTHER |