Healthcare Provider Details

I. General information

NPI: 1205896677
Provider Name (Legal Business Name): KRISTEN KANTNER LONDON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN KANTNER KANTNER

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SE MARICAMP RD STRIVE REHABILITATION
OCALA FL
34471-5582
US

IV. Provider business mailing address

1190 SE 17TH ST
OCALA FL
34471-4510
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-8883
  • Fax: 352-351-4219
Mailing address:
  • Phone: 351-732-8868
  • Fax: 352-732-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3079
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11629
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4250
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: