Provider Demographics
NPI:1285049544
Name:STANICH, KRISTINA R (PT, DPT, SCS, LAT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:R
Last Name:STANICH
Suffix:
Gender:F
Credentials:PT, DPT, SCS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 WOODSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7229
Mailing Address - Country:US
Mailing Address - Phone:405-414-8203
Mailing Address - Fax:
Practice Address - Street 1:162 WOODSIDE TRL
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7229
Practice Address - Country:US
Practice Address - Phone:405-414-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12090962251S0007X
MD293942251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports