Provider Demographics
NPI:1306802129
Name:GESSERT, KRIS A (PT)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:A
Last Name:GESSERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:A
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:757 LAKELAND DR
Mailing Address - Street 2:STE A
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1671
Mailing Address - Country:US
Mailing Address - Phone:715-723-5060
Mailing Address - Fax:
Practice Address - Street 1:757 LAKELAND DR
Practice Address - Street 2:STE A
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1671
Practice Address - Country:US
Practice Address - Phone:715-723-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40114100Medicaid
WI40114100Medicaid
0148340001Medicare NSC