Provider Demographics
NPI:1851464424
Name:FAY, KRISTA L (PT, DPT, MCMT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:FAY
Suffix:
Gender:F
Credentials:PT, DPT, MCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BREWERY RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1214
Mailing Address - Country:US
Mailing Address - Phone:845-406-0304
Mailing Address - Fax:212-207-3877
Practice Address - Street 1:136 E 57TH ST
Practice Address - Street 2:SUITE #705
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2707
Practice Address - Country:US
Practice Address - Phone:212-207-3177
Practice Address - Fax:212-207-2877
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027446-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ30R71Medicare PIN