Provider Demographics
NPI:1841412863
Name:MOSTELLER, KRISTINA DIANN
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:DIANN
Last Name:MOSTELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KRISTI
Other - Middle Name:DIANN
Other - Last Name:MOSTELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1011 HONOR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1318
Mailing Address - Country:US
Mailing Address - Phone:918-680-3828
Mailing Address - Fax:918-781-8541
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-680-3828
Practice Address - Fax:918-781-8541
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK425225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant