Healthcare Provider Details

I. General information

NPI: 1902300924
Provider Name (Legal Business Name): KRISTY DAY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 BELMONT RD
ASHDOWN AR
71822-8726
US

IV. Provider business mailing address

1705 BELMONT RD
ASHDOWN AR
71822-8726
US

V. Phone/Fax

Practice location:
  • Phone: 903-490-2095
  • Fax:
Mailing address:
  • Phone: 903-490-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4065
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2111999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: