Provider Demographics
NPI:1497901888
Name:DONASTORG, CRISTI RICE (PTA)
Entity Type:Individual
Prefix:
First Name:CRISTI
Middle Name:RICE
Last Name:DONASTORG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:CRISTI
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1100 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1838
Mailing Address - Country:US
Mailing Address - Phone:502-569-1000
Mailing Address - Fax:502-596-1411
Practice Address - Street 1:1100 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1838
Practice Address - Country:US
Practice Address - Phone:502-569-1000
Practice Address - Fax:502-596-1411
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00572225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant