1720452113 NPI number — MRS. KRISTEN LYNNE LANGBERT MS, PT

Table of content: MRS. KRISTEN LYNNE LANGBERT MS, PT (NPI 1720452113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720452113 NPI number — MRS. KRISTEN LYNNE LANGBERT MS, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGBERT
Provider First Name:
KRISTEN
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720452113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 575
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33468-0575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-745-0028
Provider Business Mailing Address Fax Number:
561-745-0833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 JUPITER LAKES BLVD
Provider Second Line Business Practice Location Address:
STE 4201
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-7190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-745-0028
Provider Business Practice Location Address Fax Number:
561-745-0833
Provider Enumeration Date:
11/23/2015

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:  PT30859 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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