Provider Demographics
NPI:1730437096
Name:MCCONNAUGHY, KRISTINA RACHEL (PTA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RACHEL
Last Name:MCCONNAUGHY
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 1:25 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4015
Mailing Address - Country:US
Mailing Address - Phone:620-662-7911
Mailing Address - Fax:
Practice Address - Street 1:25 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4015
Practice Address - Country:US
Practice Address - Phone:620-662-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02384225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant