1215164595 NPI number — MRS. JENNIFER ASTBURY KLINE PT

Table of content: MRS. JENNIFER ASTBURY KLINE PT (NPI 1215164595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215164595 NPI number — MRS. JENNIFER ASTBURY KLINE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLINE
Provider First Name:
JENNIFER
Provider Middle Name:
ASTBURY
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:
ASTBURY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215164595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22011 KENTON KNL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-7848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-325-9200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5441 BABCOCK RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-3993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-253-3888
Provider Business Practice Location Address Fax Number:
210-253-3889
Provider Enumeration Date:
06/15/2009

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:  1062545 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com