Provider Demographics
NPI:1194006379
Name:CHRISTENSEN, KRISTIN LONGWELL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LONGWELL
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:KAY
Other - Last Name:LONGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3085 MIDDLEFIELD RD
Mailing Address - Street 2:APT 8
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306
Mailing Address - Country:US
Mailing Address - Phone:208-659-6493
Mailing Address - Fax:
Practice Address - Street 1:987 UNIVERSITY AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7640
Practice Address - Country:US
Practice Address - Phone:408-395-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist