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NPI Code Detail

MEDICARE: MRS. KRISTIN JORGENSEN DPT

MEDICARE: MRS. KRISTIN JORGENSEN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist30959FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366801474
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIN JORGENSEN DPT
Provider Business Mailing Address
First Line : 1955 N FEDERAL HWY UNIT 253
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-1036
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1955 N FEDERAL HWY UNIT 253
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-1036
Country : US
Telephone Number : 954-580-2520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2016
Last Update Date : 03/12/2016

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