Provider Demographics
NPI:1063876258
Name:LEFEBVRE, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LEFEBVRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 TUCKAWAY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3900
Mailing Address - Country:US
Mailing Address - Phone:302-561-0787
Mailing Address - Fax:610-499-1231
Practice Address - Street 1:3629 MARIAN DR
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-1617
Practice Address - Country:US
Practice Address - Phone:215-805-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013793L225100000X
DEJ1-00002417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist