Provider Demographics
NPI:1679010151
Name:ELLINGTON, KRYSTLE JOY (DPT)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:JOY
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:JOY
Other - Last Name:DESQUITADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1172 THIRD AVE STE D6
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3116
Mailing Address - Country:US
Mailing Address - Phone:858-755-5200
Mailing Address - Fax:619-739-4701
Practice Address - Street 1:1172 THIRD AVE STE D6
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3116
Practice Address - Country:US
Practice Address - Phone:858-755-5200
Practice Address - Fax:619-739-4701
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292486225200000X
CAPT292486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant