Provider Demographics
NPI:1811080765
Name:HORVATH, KRISTINE DENEE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:DENEE
Last Name:HORVATH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:DENEE
Other - Last Name:KRIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 1/2 N SECOND ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120
Mailing Address - Country:US
Mailing Address - Phone:269-687-9594
Mailing Address - Fax:269-687-9543
Practice Address - Street 1:410 1/2 N SECOND ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120
Practice Address - Country:US
Practice Address - Phone:269-687-9594
Practice Address - Fax:269-687-9543
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009122225100000X
IN05005128A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232410BMedicare PIN
MIN14720006Medicare PIN