Provider Demographics
NPI:1235224031
Name:KRIET, RICHARD N (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:N
Last Name:KRIET
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 MEINECKE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1721
Mailing Address - Country:US
Mailing Address - Phone:805-541-4717
Mailing Address - Fax:805-541-4235
Practice Address - Street 1:862 MEINECKE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1721
Practice Address - Country:US
Practice Address - Phone:805-541-4717
Practice Address - Fax:805-541-4235
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist