Provider Demographics
NPI:1245659440
Name:CORKEN, KRISTA MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:CORKEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 ASBURY RD STE C
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2599
Mailing Address - Country:US
Mailing Address - Phone:563-583-0596
Mailing Address - Fax:
Practice Address - Street 1:5070 ASBURY RD STE C
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:IA
Practice Address - Zip Code:52002-2599
Practice Address - Country:US
Practice Address - Phone:563-583-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020602225100000X
IA087670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist