Provider Demographics
NPI:1194155929
Name:LASSEN, KRISTINE (MPT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:LASSEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LASSEN
Other - Last Name:NEVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:SWORD HEALTH INC 65 WADSWORTH PARK DR.
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-0580
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:SWORD HEALTH INC 65 WADSWORTH PARK DR.
Practice Address - Street 2:SUITE 230
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-0580
Practice Address - Country:US
Practice Address - Phone:385-308-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6801225100000X
MI5501019813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist