Provider Demographics
NPI:1568506764
Name:WHALEY, KRISTINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:WHALEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 990955
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0955
Mailing Address - Country:US
Mailing Address - Phone:530-243-2164
Mailing Address - Fax:530-243-9446
Practice Address - Street 1:2555 CEANOTHUS AVE.
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:530-892-2810
Practice Address - Fax:530-892-2647
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01378ZMedicare ID - Type Unspecified