Provider Demographics
NPI:1598931594
Name:WELDON, KRISTI KAY (PT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAY
Last Name:WELDON
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 1:909 N KICKAPOO AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5729
Mailing Address - Country:US
Mailing Address - Phone:405-878-8686
Mailing Address - Fax:405-878-8900
Practice Address - Street 1:909 N KICKAPOO AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5729
Practice Address - Country:US
Practice Address - Phone:405-878-8686
Practice Address - Fax:405-878-8900
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2075OtherP.TT.