Provider Demographics
NPI:1851828628
Name:HALLBERG, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HALLBERG
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 1:7502 JOHN HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5197
Mailing Address - Country:US
Mailing Address - Phone:407-484-8368
Mailing Address - Fax:
Practice Address - Street 1:6052 TURKEY LAKE RD STE 118
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4223
Practice Address - Country:US
Practice Address - Phone:407-305-2511
Practice Address - Fax:407-537-6555
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist