Provider Demographics
NPI:1740858703
Name:KREST, CHRISTIN LAKE (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:LAKE
Last Name:KREST
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 1:713 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-2047
Mailing Address - Country:US
Mailing Address - Phone:803-834-0269
Mailing Address - Fax:
Practice Address - Street 1:1166 CAMP CREEK RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-8558
Practice Address - Country:US
Practice Address - Phone:803-804-0440
Practice Address - Fax:888-673-5527
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2454225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant