Provider Demographics
NPI:1013485978
Name:GOULTAS, CHRISTINA NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:GOULTAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CLAREMONT ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1449
Mailing Address - Country:US
Mailing Address - Phone:650-685-4800
Mailing Address - Fax:
Practice Address - Street 1:800 S CLAREMONT ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1449
Practice Address - Country:US
Practice Address - Phone:650-685-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist