Provider Demographics
NPI:1871554352
Name:SULLIVAN, KRISTINA ANN (MPT, ATC, LMT)
Entity type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MPT, ATC, LMT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:A
Other - Last Name:TEMPORITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT,ATC, LMT
Mailing Address - Street 1:8120 PARKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4825
Mailing Address - Country:US
Mailing Address - Phone:314-608-9983
Mailing Address - Fax:
Practice Address - Street 1:3950 VOGEL RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3790
Practice Address - Country:US
Practice Address - Phone:636-461-0900
Practice Address - Fax:636-461-0047
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MO2009004976225100000X
MO2010036452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist