Healthcare Provider Details

I. General information

NPI: 1336654011
Provider Name (Legal Business Name): KRISTA MCAULEY MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S FLAGLER DR
WEST PALM BEACH FL
33401-6505
US

IV. Provider business mailing address

2120 GOLD AVE SE
ALBUQUERQUE NM
87106-4006
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-1596
  • Fax:
Mailing address:
  • Phone: 505-553-1596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAL5042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: