Provider Demographics
NPI:1346493467
Name:WHITE, KRISTI L (PT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:WHITE
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 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-354-2916
Mailing Address - Fax:513-588-2429
Practice Address - Street 1:6909 GOOD SAMARITAN DR
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5207
Practice Address - Country:US
Practice Address - Phone:513-245-5434
Practice Address - Fax:513-245-5424
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0031112255A2300X
OHPT.013232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01150047OtherMEDICARE RAILROAD
OH000000723681OtherANTHEM
OH0053585Medicaid
OHP01150047OtherMEDICARE RAILROAD
OH0053585Medicaid