Healthcare Provider Details

I. General information

NPI: 1154593010
Provider Name (Legal Business Name): KRISTY NIX HABADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GANDY ST NE
RUSSELLVILLE AL
35653-1913
US

IV. Provider business mailing address

352 BIG BEAR LAKE RD
PHIL CAMPBELL AL
35581-5755
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-3773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA3454
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: