Provider Demographics
NPI:1194821538
Name:MENGERINK, KRISTA L (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:L
Last Name:MENGERINK
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 1:3540 KNOLL RUN RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4874
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:6211 GENDER RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2007
Practice Address - Country:US
Practice Address - Phone:614-834-4404
Practice Address - Fax:614-834-4410
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist