MEDICARE: KRISTIN ELAINE GARNER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	2093349	TX

General Provider Information

NPI Number	:	1548620339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ELAINE GARNER PTA

Provider Business Mailing Address
First Line	:	2911 RYAN AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3443
Country	:	US
Telephone Number	:	817-723-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 W ARKANSAS LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-7601
Country	:	US
Telephone Number	:	692-622-8114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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