Provider Demographics
NPI:1235775511
Name:HEFTY, KRISTA R (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:R
Last Name:HEFTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 CORAL BAY CT APT 1
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7974
Mailing Address - Country:US
Mailing Address - Phone:502-751-2309
Mailing Address - Fax:
Practice Address - Street 1:10701 W MANSLICK RD
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9581
Practice Address - Country:US
Practice Address - Phone:502-367-2112
Practice Address - Fax:502-367-0702
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist