Provider Demographics
NPI:1619460029
Name:KRISTEK, ADAM (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:KRISTEK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 280TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66858-9820
Mailing Address - Country:US
Mailing Address - Phone:785-366-6971
Mailing Address - Fax:
Practice Address - Street 1:1514 K 96 HWY
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3012
Practice Address - Country:US
Practice Address - Phone:620-792-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist