Provider Demographics
NPI:1821505561
Name:BROSS, KRISTI L (PHYSICAL THERAPIST A)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
Last Name:BROSS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:MRS
Other - First Name:KRISTI
Other - Middle Name:L
Other - Last Name:SHIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST A
Mailing Address - Street 1:6830 W 121ST CT
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2021
Mailing Address - Country:US
Mailing Address - Phone:913-239-8777
Mailing Address - Fax:913-239-0268
Practice Address - Street 1:6830 W 121ST CT
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2021
Practice Address - Country:US
Practice Address - Phone:913-239-8777
Practice Address - Fax:913-239-0268
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2073505225200000X
IA001414225200000X
MO2001017399225200000X
KS14-01250225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant