Provider Demographics
NPI:1104973247
Name:ANDERSEN, KRISTINE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARIE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KRISTINE
Other - Middle Name:MARIE
Other - Last Name:LENAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7 NARAMORE DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2725
Mailing Address - Country:US
Mailing Address - Phone:585-343-3989
Mailing Address - Fax:
Practice Address - Street 1:7 NARAMORE DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2725
Practice Address - Country:US
Practice Address - Phone:585-343-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028027-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist