Provider Demographics
NPI:1720474992
Name:KRISJANIS, URSULA
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:KRISJANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 ROCKSPRING RD APT 21
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7010 SPRING MEADOWS DR W
Practice Address - Street 2:STE 101
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8137
Practice Address - Country:US
Practice Address - Phone:419-865-4448
Practice Address - Fax:419-865-8010
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant