Basic Information
| Provider Information | |||||||||
| NPI: | 1194006379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LONGWELL | ||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LONGWELL | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | KAY | ||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3085 MIDDLEFIELD RD | ||||||||
| Address2: | APT 8 | ||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086596493 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 987 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950327640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083957300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2011 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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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 | PT 38104 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.