Provider Demographics
NPI:1821312778
Name:VIRGIN, KRISTA (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:VIRGIN
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 1:880 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3284
Mailing Address - Country:US
Mailing Address - Phone:978-352-5510
Mailing Address - Fax:978-352-5530
Practice Address - Street 1:880 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3284
Practice Address - Country:US
Practice Address - Phone:978-352-5510
Practice Address - Fax:978-352-5530
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1659425973Medicaid
MAPT0018Medicare PIN