Provider Demographics
NPI:1952891343
Name:CHRISTENSON, KAILEY (DPT)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:CHRISTENSON
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 1:25241 ELEMENTARY WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7883
Mailing Address - Country:US
Mailing Address - Phone:239-947-4184
Mailing Address - Fax:
Practice Address - Street 1:16251 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-2176
Practice Address - Country:US
Practice Address - Phone:239-731-6222
Practice Address - Fax:239-731-6555
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10278225100000X
FLPT34597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80228876500OtherPREFERRED ONE