Provider Demographics
NPI:1134476377
Name:MEMOLY, KRISTA GAIL (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:GAIL
Last Name:MEMOLY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 SAINT GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3157
Mailing Address - Country:US
Mailing Address - Phone:732-382-7118
Mailing Address - Fax:732-634-1840
Practice Address - Street 1:767 SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3157
Practice Address - Country:US
Practice Address - Phone:732-382-7118
Practice Address - Fax:732-634-1840
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01451800225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist