MEDICARE: KRISTINA BOLANTE PT

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	5501016070	MI

General Provider Information

NPI Number	:	1972623908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA BOLANTE PT

Provider Business Mailing Address
First Line	:	2100 PARK RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 PARK RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4938
Country	:	US
Telephone Number	:	514-780-4019
Fax Number	:

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

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	04/14/2025

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Directions to “ KRISTINA BOLANTE PT” Practice Location

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