Provider Demographics
NPI:1306874300
Name:LAGE, KRISTIN J (MS, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:J
Last Name:LAGE
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S. VINE ST.
Mailing Address - Street 2:P.O. BOX 254
Mailing Address - City:ROLAND
Mailing Address - State:IA
Mailing Address - Zip Code:50236-0254
Mailing Address - Country:US
Mailing Address - Phone:515-388-4681
Mailing Address - Fax:
Practice Address - Street 1:UCLA INTERCOLLEGIATE ATHLETICS
Practice Address - Street 2:175 MORGAN CENTER; BOX 951639
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1639
Practice Address - Country:US
Practice Address - Phone:310-206-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT-10812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer