Provider Demographics
NPI:1881859866
Name:GADE, KRISTAL JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:JEAN
Last Name:GADE
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 1:260407 SEA GULL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-6933
Mailing Address - Country:US
Mailing Address - Phone:402-709-7467
Mailing Address - Fax:
Practice Address - Street 1:260407 SEA GULL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-6933
Practice Address - Country:US
Practice Address - Phone:402-709-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3664225200000X
FLPTA20612225200000X
NE764225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant