Provider Demographics
NPI:1295933919
Name:DAVIDSON, KRISTA RENEE (PT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:RENEE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 FARVIEW CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-8961
Mailing Address - Country:US
Mailing Address - Phone:812-480-9583
Mailing Address - Fax:
Practice Address - Street 1:650 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3306
Practice Address - Country:US
Practice Address - Phone:812-425-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002497A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist