Provider Demographics
NPI:1861698235
Name:KREIS, KRISTIE A (PT)
Entity type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:A
Last Name:KREIS
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 1:173 FRONT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-2536
Mailing Address - Country:US
Mailing Address - Phone:607-948-4047
Mailing Address - Fax:607-687-1209
Practice Address - Street 1:173 FRONT ST
Practice Address - Street 2:STE 1
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-2536
Practice Address - Country:US
Practice Address - Phone:607-948-4047
Practice Address - Fax:707-687-1209
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023247-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist