Provider Demographics
NPI:1700013414
Name:COOLHART, KRIS (LMT)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:COOLHART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 HIGHBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9779
Mailing Address - Country:US
Mailing Address - Phone:315-657-1329
Mailing Address - Fax:315-637-4308
Practice Address - Street 1:7313 HIGHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-9779
Practice Address - Country:US
Practice Address - Phone:315-657-1329
Practice Address - Fax:315-637-4308
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist