Basic Information
| Provider Information | |||||||||
| NPI: | 1992166631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IMHOFF | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOENING | ||||||||
| OtherFirstName: | KRISTEN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 633448 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452633448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534749 | ||||||||
| FaxNumber: | 5138534740 | ||||||||
| Practice Location | |||||||||
| Address1: | 6909 GOOD SAMARITAN DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452475208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132455434 | ||||||||
| FaxNumber: | 5132455424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2016 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 015410 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.