Healthcare Provider Details

I. General information

NPI: 1093291882
Provider Name (Legal Business Name): KILANI KRISTEN GASTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-3074
US

IV. Provider business mailing address

1991 FORDHAM DR STE 102
FAYETTEVILLE NC
28304-3774
US

V. Phone/Fax

Practice location:
  • Phone: 757-596-1900
  • Fax: 866-420-0168
Mailing address:
  • Phone: 910-484-4653
  • Fax: 910-483-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0017948
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP014581T
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70027817
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP034812T
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP034812T
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: