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General NPI Number Information
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NPI Number | 1083085476
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Entity Type | Individual
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Provider Name | KRISTA O'CONNOR PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 440-465-2892
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Fax |
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Provider Business Mailing Address
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Address Line | 8880 TIFFANY DR
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City | NORTH ROYALTON
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State | OH
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Zip | 44133-2148
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT . 015564
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License Number State | OH
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