Provider Demographics
NPI:1205896677
Name:LONDON, KRISTEN KANTNER (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:KANTNER
Last Name:LONDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:KANTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KANTNER
Mailing Address - Street 1:1190 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4510
Mailing Address - Country:US
Mailing Address - Phone:351-732-8868
Mailing Address - Fax:352-732-8890
Practice Address - Street 1:2620 SE MARICAMP RD
Practice Address - Street 2:STRIVE REHABILITATION
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5582
Practice Address - Country:US
Practice Address - Phone:352-351-8883
Practice Address - Fax:352-351-4219
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3079225100000X
FL11629225100000X
NC4250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11629OtherPT LICENSE
NC4250OtherPT LICENSE