Provider Demographics
NPI:1982931184
Name:TRANQUILLO, KRISTA ANN (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:TRANQUILLO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:HARKENRIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:12 E PENN AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551-1526
Mailing Address - Country:US
Mailing Address - Phone:717-368-4426
Mailing Address - Fax:
Practice Address - Street 1:1350 BROADCASTING RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3229
Practice Address - Country:US
Practice Address - Phone:610-685-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0041172255A2300X
NY000648-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer