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General NPI Number Information
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NPI Number | 1104173152
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Entity Type | Individual
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Provider Name | KRYSTAN N FIELDS DPT
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Gender | Female
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 4418 TELEGRAPH RD
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City | SAINT LOUIS
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State | MO
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Zip | 63129-3316
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Country | US
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Telephone | 314-894-2222
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Fax | 314-894-2223
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Provider Business Mailing Address
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Address Line | 880 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2567
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Country | US
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Telephone | 618-281-9699
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Fax | 618-281-9698
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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 | 2011021831
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License Number State | MO
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