Provider Demographics
NPI:1821228842
Name:JAECKEL, KRISTINA A (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:JAECKEL
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 1:280 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2640
Mailing Address - Country:US
Mailing Address - Phone:508-853-4590
Mailing Address - Fax:949-756-4811
Practice Address - Street 1:120 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2825
Practice Address - Country:US
Practice Address - Phone:508-453-4590
Practice Address - Fax:508-459-5900
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist