Gloria Futhey Krestan, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A0001367 Issued in MD

Practice address

4117 Stadium Drive
College Park, MD 20742-4765

Phone

(240) 825-5159

Fax

(877) 863-2802

NPI assigned

Sep 9, 2015

Last updated

Mar 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Gloria Louise Futhey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1023486099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2729 MERRILEE DR APT 535",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314445",
            "telephone_number": "803-415-4262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 STADIUM DRIVE",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207424765",
            "telephone_number": "240-825-5159",
            "fax_number": "877-863-2802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 National Guard Rd",
            "address_2": "apt 111",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292014765",
            "country_code": "US",
            "telephone_number": "803-415-4262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRESTAN",
        "first_name": "GLORIA",
        "middle_name": "FUTHEY",
        "credential": "LAT,  ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-09",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MD",
            "license": "A0001367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLORIA",
            "last_name": "FUTHEY",
            "middle_name": "LOUISE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Athletic Trainer in College Park, MD
• Providers in College Park, MD by specialty
• Athletic Trainer in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.