Active NPI
Kristine Marie Jansen, P.T.
- Physical Therapist
- Saint Peters, MO
National Provider Identifier
1205269669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01957
- Practice address
- 363 Jungermann Rd
Saint Peters, MO 63376-5371 - Phone
- (636) 928-3877
- NPI assigned
- Aug 20, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 01957 | MO | Primary |
| Physical Therapist | 225100000X | 070.018960 | IL |
Addresses
Primary practice location
363 Jungermann Rd
Saint Peters, MO 63376-5371
Mailing address
363 Jungerman Road
St. Peters, MO 63376
Phone (636) 928-3877
Other names 1
- Miss Kristine Marie Granack
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 |
|---|---|---|---|
| 070.018960 | IL | MD | Physical Therapist |
| 01957 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376956800000",
"number": "1205269669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "363 JUNGERMAN ROAD",
"city": "ST. PETERS",
"state": "MO",
"postal_code": "63376",
"telephone_number": "636-928-3877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "363 JUNGERMANN RD",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633765371",
"telephone_number": "636-928-3877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANSEN",
"first_name": "KRISTINE",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-20",
"last_updated": "2013-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "01957",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.018960",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTINE",
"last_name": "GRANACK",
"middle_name": "MARIE",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.