Provider Demographics
NPI:1194784355
Name:FRANDSEN, KRISTIN MARLENA (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARLENA
Last Name:FRANDSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22346 EAGLE RUN LN
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3122
Mailing Address - Country:US
Mailing Address - Phone:262-271-0496
Mailing Address - Fax:
Practice Address - Street 1:4348 WOODLANDS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2815
Practice Address - Country:US
Practice Address - Phone:303-660-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10382-024225100000X
COPTL.0013089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41810600Medicaid
WI363382403OtherTAX ID NUMBER
WI363382403OtherTAX ID NUMBER