Provider Demographics
NPI:1467772277
Name:KRISTOFIK, ALYSON (PT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:KRISTOFIK
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:PO BOX 8600
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985
Mailing Address - Country:US
Mailing Address - Phone:772-335-7966
Mailing Address - Fax:772-335-7963
Practice Address - Street 1:1680 SE LYNGATE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4300
Practice Address - Country:US
Practice Address - Phone:772-335-7966
Practice Address - Fax:772-335-7963
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist