Individual provider Active NPI

Krista L Boniecki, DPT

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1588059083
Registry record updated Apr 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT24761 Issued in FL
Practice address
10475 Centurion Pkwy N
Suie 220
Jacksonville, FL 32256-5003
Phone
(904) 634-0640
Fax
(904) 634-0203
NPI assigned
Apr 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT24761 FL Primary

Addresses

Primary practice location

10475 Centurion Pkwy N
Suie 220
Jacksonville, FL 32256-5003

Mailing address

6500 Bowden Rd
Suite 103
Jacksonville, FL 32216-8070
Phone (904) 634-0640

Other names 1

  • Krista L Filsinger Former name

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT24761FLMDPhysical Therapist

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427846400000",
    "number": "1588059083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 BOWDEN RD",
            "address_2": "SUITE 103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168070",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N",
            "address_2": "SUIE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565003",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONIECKI",
        "first_name": "KRISTA",
        "middle_name": "L",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2015-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT24761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "FILSINGER",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.