Provider Demographics
NPI:1477871176
Name:WILSON, KRISTINA SWETLAND (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:SWETLAND
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LYNN
Other - Last Name:SWETLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-357-5550
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:4351 CORTEZ RD W STE 201
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3217
Practice Address - Country:US
Practice Address - Phone:941-315-6182
Practice Address - Fax:941-487-6233
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ08OtherBCBS OF FL
FLY0M41OtherBCBS
FL10-6625OtherMEDICARE ID-TYPE UNSPECIFIED
FL4496768OtherAETNA
FLY0M41OtherBCBS