Healthcare Provider Details

I. General information

NPI: 1962387423
Provider Name (Legal Business Name): KRISTINA VATTAI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA FEELEY

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 LANCASTER PIKE
WILMINGTON DE
19805-1600
US

IV. Provider business mailing address

PO BOX 412727
BOSTON MA
02241-2728
US

V. Phone/Fax

Practice location:
  • Phone: 302-691-9993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE013664
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: