MEDICARE: ASHLEY LYNN KISTLER 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
1	225100000X	Physical Therapist	38362	FL

General Provider Information

NPI Number	:	1699423244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LYNN KISTLER DPT

Provider Business Mailing Address
First Line	:	5840 CORPORATE WAY STE 101
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2040
Country	:	US
Telephone Number	:	561-432-0111
Fax Number	:	561-432-1075

Provider Business Practice Location Address
First Line	:	9897 LAKE WORTH RD STE 203
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2377
Country	:	US
Telephone Number	:	561-432-0111
Fax Number	:	561-432-1075

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

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	03/14/2022

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