Provider Demographics
NPI:1558331900
Name:SNELLENBURG, KIRSTEN F (MPT)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:F
Last Name:SNELLENBURG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13830 58TH ST N
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3720
Mailing Address - Country:US
Mailing Address - Phone:727-532-1900
Mailing Address - Fax:727-532-4300
Practice Address - Street 1:13830 58TH ST N
Practice Address - Street 2:SUITE 409
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3720
Practice Address - Country:US
Practice Address - Phone:727-532-1900
Practice Address - Fax:727-532-4300
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 17873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7124Medicare ID - Type UnspecifiedMEDICARE NUMBER