Provider Demographics
NPI:1578231163
Name:OLDAKER, KRISTINA (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:OLDAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1050 INDUSTRIAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4345 KIRKWOOD HWY STE 201
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5131
Practice Address - Country:US
Practice Address - Phone:302-635-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist