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General NPI Number Information
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NPI Number | 1427294107
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Entity Type | Individual
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Provider Name | KRISTINE VAN DIJCK PT
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Gender | Female
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 601 DR MARTIN LUTHER KING JR AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3619
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Country | US
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Telephone | 314-856-3752
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Fax |
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Provider Business Mailing Address
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Address Line | 7320 FORSYTH BLVD APT 103
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City | SAINT LOUIS
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State | MO
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Zip | 63105-2167
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Country | US
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Telephone | 314-856-3752
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3511
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License Number State | NM
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