Provider Demographics
NPI:1689879470
Name:AYERS, KRISTI T (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:T
Last Name:AYERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:KRISTI
Other - Middle Name:T
Other - Last Name:ROTHROCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:70 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-9737
Mailing Address - Country:US
Mailing Address - Phone:509-322-5597
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-826-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021261225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist