Provider Demographics
NPI:1649979576
Name:LEVIN, KRISTINA (DPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PAULARINO AVE APT E205
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3269
Mailing Address - Country:US
Mailing Address - Phone:415-755-8895
Mailing Address - Fax:
Practice Address - Street 1:22 ODYSSEY STE 260
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7701
Practice Address - Country:US
Practice Address - Phone:949-748-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist