Provider Demographics
NPI:1205926425
Name:MAHLOCK, KRIS (MS, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:KRIS
Middle Name:
Last Name:MAHLOCK
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BERRY AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2937
Mailing Address - Country:US
Mailing Address - Phone:580-819-2669
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-3001
Practice Address - Country:US
Practice Address - Phone:580-774-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer