Provider Demographics
NPI:1518643774
Name:KRISTY, MICHAEL (DPT, PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KRISTY
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 E SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2768
Mailing Address - Country:US
Mailing Address - Phone:219-801-7777
Mailing Address - Fax:219-801-7677
Practice Address - Street 1:1841 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2768
Practice Address - Country:US
Practice Address - Phone:219-801-7777
Practice Address - Fax:219-801-7677
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist