Provider Demographics
NPI:1851874630
Name:MORETON, KRISTIANNA LYN (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIANNA
Middle Name:LYN
Last Name:MORETON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5229 CARTHAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1507
Mailing Address - Country:US
Mailing Address - Phone:513-488-4923
Mailing Address - Fax:
Practice Address - Street 1:5229 CARTHAGE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1507
Practice Address - Country:US
Practice Address - Phone:513-488-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09053225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant