Provider Demographics
NPI:1801186325
Name:SPANO, KRISTIAN PARIDON
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:PARIDON
Last Name:SPANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70488 HIGHWAY 21
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8134
Mailing Address - Country:US
Mailing Address - Phone:985-893-4700
Mailing Address - Fax:
Practice Address - Street 1:70488 HIGHWAY 21
Practice Address - Street 2:SUITE 400
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8134
Practice Address - Country:US
Practice Address - Phone:985-893-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist