Provider Demographics
NPI:1831677764
Name:D'EGIDIO, CHRISTA (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:D'EGIDIO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 DAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-1323
Mailing Address - Country:US
Mailing Address - Phone:330-690-7601
Mailing Address - Fax:
Practice Address - Street 1:362 W BURR BLVD
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-4787
Practice Address - Country:US
Practice Address - Phone:304-900-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WVPT004009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist