Healthcare Provider Details

I. General information

NPI: 1215188396
Provider Name (Legal Business Name): KRISTA CLINTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 NATIONAL AVE 100
LOS GATOS CA
95032-2425
US

IV. Provider business mailing address

249 LOS GATOS BLVD 2
LOS GATOS CA
95030-6126
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-7326
  • Fax:
Mailing address:
  • Phone: 414-699-7494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: