Provider Demographics
NPI:1306895503
Name:EDIGER, KRISTINA ANN (RPT)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:ANN
Last Name:EDIGER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3426
Mailing Address - Country:US
Mailing Address - Phone:580-237-5711
Mailing Address - Fax:580-249-5999
Practice Address - Street 1:2501 MERCER DR
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-8602
Practice Address - Country:US
Practice Address - Phone:580-233-0666
Practice Address - Fax:580-249-5999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK639OtherPT LICENSE NUMBER