Basic Information
| Provider Information | |||||||||
| NPI: | 1811337082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4326 CAHUENGA BLVD | ||||||||
| Address2: | APT 7 | ||||||||
| City: | TOLUCA LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916022765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618777389 | ||||||||
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| Practice Location | |||||||||
| Address1: | 488 S SAN VICENTE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900484107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236559055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2013 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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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 | 40374 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.