Active NPI
Kristal Lee Blundell, PTA
- Physical Therapy Assistant
- Lake Havasu City, AZ
National Provider Identifier
1013356773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 10274APTA
- Practice address
- 1515 Lake Havasu Ave N Ste 100
Lake Havasu City, AZ 86404-1177 - Phone
- (928) 854-5439
- NPI assigned
- Jun 17, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 10274APTA | AZ | Primary |
Addresses
Primary practice location
1515 Lake Havasu Ave N Ste 100
Lake Havasu City, AZ 86404-1177
Mailing address
3490 Overland Dr
Lake Havasu City, AZ 86404-2203
Phone (928) 230-2715
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10274APTA | AZ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683676800000",
"number": "1013356773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3490 OVERLAND DR",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864042203",
"telephone_number": "928-230-2715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 LAKE HAVASU AVE N STE 100",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864041177",
"telephone_number": "928-854-5439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUNDELL",
"first_name": "KRISTAL",
"middle_name": "LEE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-17",
"last_updated": "2023-05-10",
"certification_date": "2023-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AZ",
"license": "10274APTA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Havasu City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.