Provider Demographics
NPI:1639503402
Name:KRSKA, TRISHA LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNN
Last Name:KRSKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:LYNN
Other - Last Name:EBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:103 SW EAGLES PKWY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8512
Practice Address - Country:US
Practice Address - Phone:816-443-2375
Practice Address - Fax:816-443-2380
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013029927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
49549012OtherBCBS KC
MOMA4370061OtherMEDICARE PTAN