Provider Demographics
NPI:1548291552
Name:KRISTJAN FRIDRIKSSON PHYSICAL THERAPY SERVICES, INC
Entity type:Organization
Organization Name:KRISTJAN FRIDRIKSSON PHYSICAL THERAPY SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTJAN
Authorized Official - Middle Name:INGI
Authorized Official - Last Name:FRIDRIKSSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:251-343-1178
Mailing Address - Street 1:5901 GRELOT RD
Mailing Address - Street 2:BUILDING B, SUITE B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609
Mailing Address - Country:US
Mailing Address - Phone:251-343-1178
Mailing Address - Fax:251-343-1741
Practice Address - Street 1:5901 GRELOT RD
Practice Address - Street 2:BUILDING B, SUITE B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3603
Practice Address - Country:US
Practice Address - Phone:251-343-1178
Practice Address - Fax:251-343-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3558261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51501631OtherBCBS OF ALABAMA
AL051501631Medicare ID - Type Unspecified
AL51501631OtherBCBS OF ALABAMA