Provider Demographics
NPI:1679650915
Name:KING, KRISTIE L (RPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:KS
Mailing Address - Zip Code:66549
Mailing Address - Country:US
Mailing Address - Phone:785-457-0151
Mailing Address - Fax:
Practice Address - Street 1:105 N HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:KS
Practice Address - Zip Code:66549-9695
Practice Address - Country:US
Practice Address - Phone:785-457-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141098OtherBLUE SHIELD