Provider Demographics
NPI:1376877803
Name:CONSIGLIO-LAHTI, KRISTA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:CONSIGLIO-LAHTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:M
Other - Last Name:CASTELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1801 ORANGE TREE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4587
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-557-1732
Practice Address - Street 1:15325 FAIRFIELD RANCH RD STE 150
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-8842
Practice Address - Country:US
Practice Address - Phone:099-557-1668
Practice Address - Fax:909-557-1677
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACN828ZMedicare PIN