Provider Demographics
NPI:1194091264
Name:FLEMING, KRISTA TERESE (LMT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:TERESE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 BADER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-5228
Mailing Address - Country:US
Mailing Address - Phone:216-509-4398
Mailing Address - Fax:
Practice Address - Street 1:25901 EMERY RD STE 103
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-6213
Practice Address - Country:US
Practice Address - Phone:216-364-0152
Practice Address - Fax:216-364-0157
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015221 E-G225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10672910001OtherBWC