Provider Demographics
NPI:1477732220
Name:LEVERENZ, KRISTIE P (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:P
Last Name:LEVERENZ
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 1:7411 112TH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-9121
Mailing Address - Country:US
Mailing Address - Phone:563-343-4730
Mailing Address - Fax:
Practice Address - Street 1:1209 21ST AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7900
Practice Address - Country:US
Practice Address - Phone:563-343-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist