Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT12576 | CA |
NPI | 1205458106 |
---|---|
Provider Name | Ms. Kristina Louise Nielsen |
First Address | Santa Barbara, CA 93110-2852 |
Second Address | Santa Barbara, CA 93110-2852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2020 |
Last Update Date | 13/05/2020 |