Provider Demographics
NPI:1336548312
Name:KMETZ, KRISTI (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KMETZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 S NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3920
Mailing Address - Country:US
Mailing Address - Phone:918-697-4174
Mailing Address - Fax:
Practice Address - Street 1:2417 E 53RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6600
Practice Address - Country:US
Practice Address - Phone:918-712-8412
Practice Address - Fax:918-712-8413
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist