Provider Demographics
NPI:1598208845
Name:LANDI, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LANDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:K.
Other - Middle Name:ASHLEY
Other - Last Name:LANDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7693 LAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:UPATOI
Mailing Address - State:GA
Mailing Address - Zip Code:31829-1704
Mailing Address - Country:US
Mailing Address - Phone:706-593-7548
Mailing Address - Fax:
Practice Address - Street 1:7693 LAYFIELD RD
Practice Address - Street 2:
Practice Address - City:UPATOI
Practice Address - State:GA
Practice Address - Zip Code:31829-1704
Practice Address - Country:US
Practice Address - Phone:706-593-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0021282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer