Provider Demographics
NPI:1235333071
Name:KRISTOFF, ANDREA R (MPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:KRISTOFF
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:R
Other - Last Name:BEAUCHAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:7162 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9409
Mailing Address - Country:US
Mailing Address - Phone:913-962-7770
Mailing Address - Fax:913-962-7775
Practice Address - Street 1:7162 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9409
Practice Address - Country:US
Practice Address - Phone:913-962-7770
Practice Address - Fax:913-962-7775
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03704225100000X
MO2007022727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS38437012OtherBCBS
KST29F299Medicare PIN