Provider Demographics
NPI:1235297177
Name:MOORE, KRISTI L (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BLUE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9213
Mailing Address - Country:US
Mailing Address - Phone:406-251-2323
Mailing Address - Fax:406-251-2999
Practice Address - Street 1:5000 BLUE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-9213
Practice Address - Country:US
Practice Address - Phone:406-251-2323
Practice Address - Fax:406-251-2999
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011003606Medicare PIN
MT000050667Medicare ID - Type Unspecified