Provider Demographics
NPI:1235146887
Name:LIST, KRISTY LYNN (ATC)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:LYNN
Last Name:LIST
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 W TUSCOLA ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1433
Mailing Address - Country:US
Mailing Address - Phone:989-239-3381
Mailing Address - Fax:
Practice Address - Street 1:619 W TUSCOLA ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1433
Practice Address - Country:US
Practice Address - Phone:989-239-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer