Provider Demographics
NPI:1699907014
Name:DAVIDSON, KRISTA LEIGH (MSCPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LEIGH
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6163 WINDING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4585
Mailing Address - Country:US
Mailing Address - Phone:804-730-1794
Mailing Address - Fax:804-706-7431
Practice Address - Street 1:6800 LUCY CORR CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6657
Practice Address - Country:US
Practice Address - Phone:804-706-5692
Practice Address - Fax:804-706-4731
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist