Healthcare Provider Details

I. General information

NPI: 1003285537
Provider Name (Legal Business Name): ALEXANDRA KRISIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 W GREENWAY ST
DERBY KS
67037-2641
US

IV. Provider business mailing address

4617 W 20TH ST SUITE A
GREELEY CO
80634-3207
US

V. Phone/Fax

Practice location:
  • Phone: 316-788-6734
  • Fax: 316-788-4529
Mailing address:
  • Phone: 970-352-9022
  • Fax: 970-352-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-06700
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0013636
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: