Provider Demographics
NPI:1174647861
Name:ANDERSON, KRISTI LYNN (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MEADOWLARK DR
Mailing Address - Street 2:APT #4
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1767
Mailing Address - Country:US
Mailing Address - Phone:262-767-7121
Mailing Address - Fax:
Practice Address - Street 1:300 MC CANNA PKWY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-3622
Practice Address - Country:US
Practice Address - Phone:262-767-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6790392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer