Provider Demographics
NPI:1366041477
Name:HANZLICEK, KRISTA
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HANZLICEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-6241
Mailing Address - Fax:
Practice Address - Street 1:2660 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2442
Practice Address - Country:US
Practice Address - Phone:785-270-8880
Practice Address - Fax:785-270-8881
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03691225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant