Provider Demographics
NPI:1629479159
Name:DWORMAN, KRISTI LARSEN (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:LARSEN
Last Name:DWORMAN
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 1:31778 OAK RANCH CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4766
Mailing Address - Country:US
Mailing Address - Phone:818-577-0770
Mailing Address - Fax:818-597-0052
Practice Address - Street 1:31778 OAK RANCH CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4766
Practice Address - Country:US
Practice Address - Phone:818-577-0770
Practice Address - Fax:818-597-0052
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist