Provider Demographics
NPI:1174073357
Name:MAYA, KRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:MAYA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:FRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5901 E FOWLER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2305
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 240B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1203
Practice Address - Country:US
Practice Address - Phone:727-461-6026
Practice Address - Fax:727-397-0562
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022735225100000X
FLPT41504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist