Provider Demographics
NPI:1003990649
Name:LOUNSBERRY, KRISTINA ADELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ADELE
Last Name:LOUNSBERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 S CITIES SERVICE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-7500
Mailing Address - Country:US
Mailing Address - Phone:337-497-1464
Mailing Address - Fax:337-497-1465
Practice Address - Street 1:299 S CITIES SERVICE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-7500
Practice Address - Country:US
Practice Address - Phone:337-497-1464
Practice Address - Fax:337-497-1465
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA06506OtherLICENSE NUMBER