Basic Information
| Provider Information | |||||||||
| NPI: | 1790265940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORNDORFF | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 534 W NEW HOPE RD APT B8 | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275347579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197316005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7580 CHARLOTTE HWY STE 1100 | ||||||||
| Address2: | |||||||||
| City: | FORT MILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297077803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035485662 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2018 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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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 | P16862 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.