Provider Demographics
NPI:1639172729
Name:KISSINGER, CHRISTINE (PT, MPT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:10060 REGENCY CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3732
Practice Address - Country:US
Practice Address - Phone:402-354-1490
Practice Address - Fax:402-354-1495
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6384225100000X
NE3156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025941700Medicaid
NE10026056700Medicaid
NE10025896000Medicaid
NE10025896100Medicaid
NE10026252200Medicaid
NE10025895900Medicaid
IA1639172729Medicaid
NE099099172Medicare PIN