Provider Demographics
NPI:1427304484
Name:GOODRIDGE, KRISTIN ASHLEY (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ASHLEY
Last Name:GOODRIDGE
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 1:2875 BARN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6389
Mailing Address - Country:US
Mailing Address - Phone:540-639-5786
Mailing Address - Fax:540-633-0787
Practice Address - Street 1:2875 BARN RD STE 100
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6389
Practice Address - Country:US
Practice Address - Phone:540-639-5786
Practice Address - Fax:540-633-0787
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004978803Medicaid
VA004978803Medicaid