Healthcare Provider Details

I. General information

NPI: 1699921791
Provider Name (Legal Business Name): KRISTINE C VROOM M.S., P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31271 NIGUEL RD STE J
LAGUNA NIGUEL CA
92677-4135
US

IV. Provider business mailing address

2 MINORI
LAGUNA NIGUEL CA
92677-9046
US

V. Phone/Fax

Practice location:
  • Phone: 949-443-5442
  • Fax: 949-443-5463
Mailing address:
  • Phone: 949-495-9031
  • Fax: 949-495-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 14109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: