Provider Demographics
NPI:1336315209
Name:PINNOW, KRISTA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:PINNOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 HUMES RD
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-9622
Mailing Address - Country:US
Mailing Address - Phone:608-373-2500
Mailing Address - Fax:
Practice Address - Street 1:2540 HUMES RD
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-9622
Practice Address - Country:US
Practice Address - Phone:608-373-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10174-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60245OtherDEAN HEALTH INSURANCE