Provider Demographics
NPI:1629238761
Name:LIST, KRISTY (MPT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:LIST
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 SEAL BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2754
Mailing Address - Country:US
Mailing Address - Phone:949-551-3860
Mailing Address - Fax:
Practice Address - Street 1:13001 SEAL BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2754
Practice Address - Country:US
Practice Address - Phone:949-551-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278732251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic