Provider Demographics
NPI:1508187428
Name:MCMAHAN, KRISTI J (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:J
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:J
Other - Last Name:KJELLGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3875 E OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9005
Mailing Address - Country:US
Mailing Address - Phone:208-489-5060
Mailing Address - Fax:208-489-5061
Practice Address - Street 1:3875 E OVERLAND RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9005
Practice Address - Country:US
Practice Address - Phone:208-489-5060
Practice Address - Fax:208-489-5061
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID-19822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic