Provider Demographics
NPI:1255597639
Name:LESANTI, KRISTIN ANGEL (PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANGEL
Last Name:LESANTI
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 1:1801 GRAND ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2249
Mailing Address - Country:US
Mailing Address - Phone:716-773-4323
Mailing Address - Fax:716-773-9418
Practice Address - Street 1:1801 GRAND ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2249
Practice Address - Country:US
Practice Address - Phone:716-773-4323
Practice Address - Fax:716-773-9418
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1255597636Medicare PIN