Provider Demographics
NPI:1104972991
Name:KHAN, CRISTINA ELDIDY (DPT)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELDIDY
Last Name:KHAN
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 1:301 3RD LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3547
Mailing Address - Country:US
Mailing Address - Phone:561-691-0967
Mailing Address - Fax:
Practice Address - Street 1:8895 N MILITARY TRL
Practice Address - Street 2:BLDG E, SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6220
Practice Address - Country:US
Practice Address - Phone:561-624-1457
Practice Address - Fax:561-775-3290
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891536900Medicaid