Provider Demographics
NPI:1407253438
Name:GILDAY, KRISTA DEE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:DEE
Last Name:GILDAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3376
Mailing Address - Country:US
Mailing Address - Phone:540-371-8250
Mailing Address - Fax:540-371-0705
Practice Address - Street 1:421 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3376
Practice Address - Country:US
Practice Address - Phone:540-371-8250
Practice Address - Fax:540-371-0705
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603879225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant