Provider Demographics
NPI:1881094829
Name:VARNER, KRISTA KIM (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:KIM
Last Name:VARNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1620
Mailing Address - Country:US
Mailing Address - Phone:419-878-8449
Mailing Address - Fax:
Practice Address - Street 1:1867 N RESEARCH DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-8835
Practice Address - Country:US
Practice Address - Phone:419-354-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-09154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist