Active NPI
Deborah Jean Kristovich, PT
- Physical Therapist
- Tacoma, WA
National Provider Identifier
1194795997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 2312 N 30TH St
Ste 101
Tacoma, WA 98403 - Phone
- (253) 396-9001
- Fax
- (253) 396-1231
- NPI assigned
- Jan 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | WA | Primary |
Addresses
Primary practice location
2312 N 30TH St
Ste 101
Tacoma, WA 98403
Mailing address
2312 N 30TH St
Ste 101
Tacoma, WA 98403
Phone (253) 396-9001
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0152660 | Other | WA | LABOR AND INDUSTRIES |
| 710935 | Medicaid | WA | |
| 0152661 | Other | WA | L AND I GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283472000000",
"number": "1194795997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2312 N 30TH ST",
"address_2": "STE 101",
"city": "TACOMA",
"state": "WA",
"postal_code": "98403",
"telephone_number": "253-396-9001",
"fax_number": "253-396-1231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2312 N 30TH ST",
"address_2": "STE 101",
"city": "TACOMA",
"state": "WA",
"postal_code": "98403",
"telephone_number": "253-396-9001",
"fax_number": "253-396-1231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISTOVICH",
"first_name": "DEBORAH",
"middle_name": "JEAN",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-24",
"last_updated": "2010-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRIES",
"identifier": "0152660",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "710935",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L AND I GROUP",
"identifier": "0152661",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.