Provider Demographics
NPI:1871675454
Name:FROMM, KRISTA LEE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEE
Last Name:FROMM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:LEE
Other - Last Name:REGENSCHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9219 HILLSBORO WAY
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2108
Mailing Address - Country:US
Mailing Address - Phone:952-994-3495
Mailing Address - Fax:
Practice Address - Street 1:622 ABERDEEN AVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-9516
Practice Address - Country:US
Practice Address - Phone:952-492-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist