MEDICARE: KRISTEN M KLINGEN M.P.T.

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
1	225100000X	Physical Therapist	PT008457L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2331048000	OTHER	PA	PERSONAL CHOICE PROVIDER#
2	5620457	OTHER	PA	AETNA TRADITIONAL PROV. #
3	1654463	OTHER		BC/BS PIN
4	2331048000	OTHER	PA	KEYSTONE PIN
5	1170988	OTHER	PA	AETNA HMO PROVIDER #

General Provider Information

NPI Number	:	1679507735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN M KLINGEN M.P.T.

Provider Business Mailing Address
First Line	:	146 COLUMBUS AVE
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-3313
Country	:	US
Telephone Number	:	610-789-0114
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 W EAGLE RD
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2234
Country	:	US
Telephone Number	:	610-789-9887
Fax Number	:	610-789-9883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	02/27/2008

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