Provider Demographics
NPI:1972767770
Name:KRISTOBAK, JANET M
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:M
Last Name:KRISTOBAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:PRENTICE
Other - Last Name:KRISTOBAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3236 STATE ROUTE 257 SUITE 1
Mailing Address - Street 2:PO BOX 248
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0248
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:TIDIOUTE
Practice Address - State:PA
Practice Address - Zip Code:16351-1056
Practice Address - Country:US
Practice Address - Phone:814-484-1100
Practice Address - Fax:814-484-1102
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003436L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13580040OtherCAQH