Provider Demographics
NPI:1316376213
Name:BATES, KRIS DUANE (CPT, LPTA)
Entity Type:Individual
Prefix:MR
First Name:KRIS
Middle Name:DUANE
Last Name:BATES
Suffix:
Gender:M
Credentials:CPT, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2106
Mailing Address - Country:US
Mailing Address - Phone:218-340-8714
Mailing Address - Fax:
Practice Address - Street 1:515 GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-2106
Practice Address - Country:US
Practice Address - Phone:218-340-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA358225200000X
TX5934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist