Provider Demographics
NPI:1972226033
Name:SELLERS, KRISTA (PTA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:SELLERS
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 1:247 E KODIAK CT
Mailing Address - Street 2:
Mailing Address - City:KECHI
Mailing Address - State:KS
Mailing Address - Zip Code:67067-7606
Mailing Address - Country:US
Mailing Address - Phone:316-461-9969
Mailing Address - Fax:
Practice Address - Street 1:10665 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5600
Practice Address - Country:US
Practice Address - Phone:316-285-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03228225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant