Provider Demographics
NPI:1447440144
Name:SCHMIDT, KRISTINA FLAVIA (LMT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:FLAVIA
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRISTINS
Other - Middle Name:FLAVIA
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:10141 PINK PALMATA CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3626
Mailing Address - Country:US
Mailing Address - Phone:813-300-2321
Mailing Address - Fax:
Practice Address - Street 1:10141 PINK PALMATA CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3626
Practice Address - Country:US
Practice Address - Phone:813-300-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38042225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC107NOtherBCBSFL