Provider Demographics
NPI:1174874085
Name:DUGAN, KRISTA JACLYN (MPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:JACLYN
Last Name:DUGAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 DOVER AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3617
Mailing Address - Country:US
Mailing Address - Phone:614-832-2225
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2262
Practice Address - Country:US
Practice Address - Phone:614-889-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH107042251G0304X
NV18662251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics