Provider Demographics
NPI:1215992375
Name:KRISTL, CLAIRE ANN (PT, MPA)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:ANN
Last Name:KRISTL
Suffix:
Gender:F
Credentials:PT, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MIRAMONTE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9433
Mailing Address - Country:US
Mailing Address - Phone:831-659-4274
Mailing Address - Fax:
Practice Address - Street 1:245 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8650
Practice Address - Country:US
Practice Address - Phone:831-620-0744
Practice Address - Fax:831-620-0711
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT12926OtherSTATE LICENSE
CAPT12926OtherSTATE LICENSE