Provider Demographics
NPI:1457672537
Name:HIMMELRICK, KRISTINE J (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:J
Last Name:HIMMELRICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:J
Other - Last Name:TOTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:27125 SIERRA HWY
Mailing Address - Street 2:STE 203
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5428
Mailing Address - Country:US
Mailing Address - Phone:661-250-9940
Mailing Address - Fax:661-250-9959
Practice Address - Street 1:11225 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-1610
Practice Address - Country:US
Practice Address - Phone:818-363-9970
Practice Address - Fax:818-363-9980
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist