Provider Demographics
NPI:1245710961
Name:LEDDON, KRISTINA (DPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:LEDDON
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 1:606 MADSEN DR
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-2526
Mailing Address - Country:US
Mailing Address - Phone:770-656-2137
Mailing Address - Fax:
Practice Address - Street 1:4318 SPYRES WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9259
Practice Address - Country:US
Practice Address - Phone:209-576-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist