1073687117 NPI number — MRS. KRISTIN C SCHRAUBENWELLER PT

Table of content: MRS. KRISTIN C SCHRAUBENWELLER PT (NPI 1073687117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073687117 NPI number — MRS. KRISTIN C SCHRAUBENWELLER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRAUBENWELLER
Provider First Name:
KRISTIN
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLER
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073687117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412031
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-294-4050
Provider Business Mailing Address Fax Number:
631-760-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3751 S STATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-522-0066
Provider Business Practice Location Address Fax Number:
616-527-1667
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501012502 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com