Provider Demographics
NPI:1528191301
Name:GAULT, KRISTA JEANNE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:JEANNE
Last Name:GAULT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:JEANNE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2845 SW 37TH CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8307
Mailing Address - Country:US
Mailing Address - Phone:541-504-6965
Mailing Address - Fax:541-548-8302
Practice Address - Street 1:3025 SW RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9481
Practice Address - Country:US
Practice Address - Phone:541-548-5066
Practice Address - Fax:541-548-8302
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23642251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics