Provider Demographics
NPI:1528290210
Name:DORRIS, KRISTOPHER CARL (PT)
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:CARL
Last Name:DORRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SE WALLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-5403
Mailing Address - Country:US
Mailing Address - Phone:580-585-5577
Mailing Address - Fax:580-248-9377
Practice Address - Street 1:602 SE WALLOCK ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-5403
Practice Address - Country:US
Practice Address - Phone:580-585-5577
Practice Address - Fax:580-248-9377
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161350225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB164135Medicare PIN