Healthcare Provider Details

I. General information

NPI: 1144600420
Provider Name (Legal Business Name): KRISTA CRIDER PTA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 7TH ST
CHAMBERSBURG PA
17201-1720
US

IV. Provider business mailing address

112 N 7TH ST
CHAMBERSBURG PA
17201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 717-262-4650
  • Fax:
Mailing address:
  • Phone: 717-816-0256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE012350
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126002538
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000020272
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: