Provider Demographics
NPI:1073709911
Name:KLEIN, KRISTOPHER DONALD (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:DONALD
Last Name:KLEIN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 LONGBOW RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-4441
Mailing Address - Country:US
Mailing Address - Phone:321-302-1234
Mailing Address - Fax:
Practice Address - Street 1:3668 LONGBOW RD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-4441
Practice Address - Country:US
Practice Address - Phone:321-302-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 12492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer