Provider Demographics
NPI:1497739759
Name:MANKIN, KRIS (MPT)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:MANKIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHOSHAWANA
Other - Middle Name:KRISTINE
Other - Last Name:MANKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:33129 CHEYENNE CIR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8745
Mailing Address - Country:US
Mailing Address - Phone:714-743-0965
Mailing Address - Fax:
Practice Address - Street 1:24671 MONROE AVE STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-677-4105
Practice Address - Fax:951-677-4106
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA168966Medicare PIN
CACA168964Medicare PIN
CACA168965Medicare PIN