Provider Demographics
NPI:1275828378
Name:LEAKE, KRISTA (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:
Last Name:LEAKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 RIVERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2030
Mailing Address - Country:US
Mailing Address - Phone:434-200-5032
Mailing Address - Fax:
Practice Address - Street 1:801 WYNDHURST DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2550
Practice Address - Country:US
Practice Address - Phone:434-237-8160
Practice Address - Fax:434-237-8161
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050053962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic