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General NPI Number Information
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NPI Number | 1669208849
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Entity Type | Individual
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Provider Name | KRISTINA ANNE REZOWALLI PT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 2724 SOQUEL AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-1433
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Country | US
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Telephone | 831-475-2565
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Fax |
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Provider Business Mailing Address
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Address Line | 372 SEA RIDGE RD APT 4
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City | APTOS
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State | CA
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Zip | 95003-4340
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Country | US
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Telephone | 408-656-9986
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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 | 297345
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License Number State | CA
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