Provider Demographics
NPI:1811227879
Name:DRAKE, KRISTI MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARIE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PACERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9769
Mailing Address - Country:US
Mailing Address - Phone:724-344-3337
Mailing Address - Fax:
Practice Address - Street 1:1290 BOYCE RD
Practice Address - Street 2:
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-3921
Practice Address - Country:US
Practice Address - Phone:724-941-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003206225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant