Provider Demographics
NPI:1215188396
Name:CLINTON, KRISTA (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 LOS GATOS BLVD
Mailing Address - Street 2:2
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6126
Mailing Address - Country:US
Mailing Address - Phone:414-699-7494
Mailing Address - Fax:
Practice Address - Street 1:15215 NATIONAL AVE
Practice Address - Street 2:100
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2425
Practice Address - Country:US
Practice Address - Phone:408-358-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist