Provider Demographics
NPI:1063555290
Name:DEMRY, KRISTY JO (PTA)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:JO
Last Name:DEMRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19345 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-8340
Mailing Address - Country:US
Mailing Address - Phone:641-437-1081
Mailing Address - Fax:
Practice Address - Street 1:612 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1511
Practice Address - Country:US
Practice Address - Phone:641-856-2515
Practice Address - Fax:641-856-2516
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00091225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant