Healthcare Provider Details

I. General information

NPI: 1598362873
Provider Name (Legal Business Name): KRISTY DAO ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N FAIRVIEW ST
LOCK HAVEN PA
17745-2342
US

IV. Provider business mailing address

810 E WATER ST APT 31
LOCK HAVEN PA
17745-1522
US

V. Phone/Fax

Practice location:
  • Phone: 316-737-8332
  • Fax:
Mailing address:
  • Phone: 316-737-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000038640
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0000
Identifier TypeOTHER
Identifier State
Identifier IssuerN/A

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: