Provider Demographics
NPI:1326345117
Name:INGLIS, KRISTA ELLEN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:ELLEN
Last Name:INGLIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1804 N PLACENTIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2303
Mailing Address - Country:US
Mailing Address - Phone:714-528-9400
Mailing Address - Fax:714-528-9403
Practice Address - Street 1:1804 N PLACENTIA AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-2303
Practice Address - Country:US
Practice Address - Phone:714-528-9400
Practice Address - Fax:714-528-9403
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 254392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics