Healthcare Provider Details

I. General information

NPI: 1720992399
Provider Name (Legal Business Name): KRYSTOPHER RIDGE SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 S US HIGHWAY 59
PARSONS KS
67357-4948
US

IV. Provider business mailing address

1902 S US HIGHWAY 59
PARSONS KS
67357-4948
US

V. Phone/Fax

Practice location:
  • Phone: 620-421-4881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-08205
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: