Provider Demographics
NPI:1831252774
Name:ANDRAKA, KRISTIN MARIE ASH (DPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARIE ASH
Last Name:ANDRAKA
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 1:1502 EASTPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4347
Mailing Address - Country:US
Mailing Address - Phone:989-954-5122
Mailing Address - Fax:
Practice Address - Street 1:1627 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5429
Practice Address - Country:US
Practice Address - Phone:989-779-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6269OtherSTATE LICENSE
AZ981375Medicaid