Provider Demographics
NPI:1881683316
Name:O'CONNOR-NYQUIST, KRISTI A (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:A
Last Name:O'CONNOR-NYQUIST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 N 7TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2598
Mailing Address - Country:US
Mailing Address - Phone:406-586-2772
Mailing Address - Fax:
Practice Address - Street 1:2430 N 7TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2598
Practice Address - Country:US
Practice Address - Phone:406-586-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8402018Medicaid
WAP63701Medicare UPIN
WA8402018Medicaid