Provider Demographics
NPI:1083810899
Name:PETROSKY, KRISTIN NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE
Last Name:PETROSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8099 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2231
Mailing Address - Country:US
Mailing Address - Phone:513-985-2256
Mailing Address - Fax:513-389-3666
Practice Address - Street 1:8099 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2231
Practice Address - Country:US
Practice Address - Phone:513-985-2256
Practice Address - Fax:513-389-3666
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 011791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2753391Medicaid
OHP00604757OtherMEDICARE RAILROAD
OHP00604757OtherMEDICARE RAILROAD