Healthcare Provider Details

I. General information

NPI: 1700025723
Provider Name (Legal Business Name): KRISTI LOUISE HUENEFELD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 DAVIS BLVD
NAPLES FL
34104-5314
US

IV. Provider business mailing address

521 NEAPOLITAN LN
NAPLES FL
34103-8532
US

V. Phone/Fax

Practice location:
  • Phone: 239-793-1986
  • Fax:
Mailing address:
  • Phone: 239-250-0975
  • Fax: 239-262-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: