Kristine Baltazar

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01924000 Issued in NJ

Practice address

3442 Cypress Club Dr
Charlotte, NC 28210-2467

Phone

(704) 714-5500

NPI assigned

Jul 21, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prospect Medical PC

  • Internal Medicine Physician
  • Hackensack, NJ
  • NPI 1346365905
  NPD (past)

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1629686191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5404 MIDVALE TER",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158600",
            "telephone_number": "201-873-4694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3442 CYPRESS CLUB DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282102467",
            "telephone_number": "704-714-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALTAZAR",
        "first_name": "KRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-21",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P22857",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "047286",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01924000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Usha Balmuri, MD
• Valerie G. Balog
• Morayo Balogun
• Carlee Cooper Balser, LCMHC
• Cesilia Baltazar, PHARMD
• Jonathan Robert Baltzell, PA-C
• Kayla Bamberg, OTR/L
• Daniel Andrew Bambini, M.D.
• Vanitha Banajjar Revanasiddappa, MD
• Zuzana Rajecka Banas, MD

• All providers in Charlotte, NC
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; 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.