Provider Demographics
NPI:1821596222
Name:SOCIAS, KRISTINA FAITH ESCLARES (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTINA FAITH
Middle Name:ESCLARES
Last Name:SOCIAS
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 1:6556 W FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93723-3000
Mailing Address - Country:US
Mailing Address - Phone:419-307-6480
Mailing Address - Fax:
Practice Address - Street 1:5555 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6006
Practice Address - Country:US
Practice Address - Phone:559-439-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49060225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant