Provider Demographics
NPI:1023499852
Name:TRASK, KRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:TRASK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:WEILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:520 S PIERCE AVE
Mailing Address - Street 2:#224
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2749
Mailing Address - Country:US
Mailing Address - Phone:641-421-8584
Mailing Address - Fax:
Practice Address - Street 1:520 S PIERCE AVE
Practice Address - Street 2:#224
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2749
Practice Address - Country:US
Practice Address - Phone:641-421-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist