Provider Demographics
NPI:1568477362
Name:LEISKE, CRISTA RAINELLE (MPT)
Entity type:Individual
Prefix:MS
First Name:CRISTA
Middle Name:RAINELLE
Last Name:LEISKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:CRISTA
Other - Middle Name:RAINELLE
Other - Last Name:CROMBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:52333 AVENIDA HERRERA
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3273
Mailing Address - Country:US
Mailing Address - Phone:760-564-9989
Mailing Address - Fax:
Practice Address - Street 1:81557 DOCTOR CARREON BLVD
Practice Address - Street 2:SUITE C8
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5517
Practice Address - Country:US
Practice Address - Phone:760-775-5511
Practice Address - Fax:760-775-5521
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT225970OtherPPIN