Provider Demographics
NPI:1417405556
Name:HAAS, KRISTI ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ANN
Last Name:HAAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ANN
Other - Last Name:THORWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1076 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2617
Mailing Address - Country:US
Mailing Address - Phone:763-232-4665
Mailing Address - Fax:
Practice Address - Street 1:2495 MAPLEWOOD DR N STE 313
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1985
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:651-770-8151
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016038138225100000X
MN12110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist