Provider Demographics
NPI:1659471860
Name:ALBRECHT, KRISTINE LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:LYNN
Last Name:ALBRECHT
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:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615
Mailing Address - Country:US
Mailing Address - Phone:520-366-5292
Mailing Address - Fax:
Practice Address - Street 1:805 E FREEMONT
Practice Address - Street 2:
Practice Address - City:TOMBSTONE
Practice Address - State:AZ
Practice Address - Zip Code:85638
Practice Address - Country:US
Practice Address - Phone:520-457-2217
Practice Address - Fax:520-457-3270
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42442251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ424523Medicaid