Provider Demographics
NPI:1467765974
Name:BASS, KRISTINA RAE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RAE
Last Name:BASS
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 1:3225 S NOLAND RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-1317
Mailing Address - Country:US
Mailing Address - Phone:816-521-5300
Mailing Address - Fax:816-521-2999
Practice Address - Street 1:3225 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-1317
Practice Address - Country:US
Practice Address - Phone:816-521-5300
Practice Address - Fax:816-521-2999
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000173360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist