Healthcare Provider Details

I. General information

NPI: 1699104950
Provider Name (Legal Business Name): KRISTI MASCHAL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 W INTERSTATE 20 STE: 204
ARLINGTON TX
76017-1677
US

IV. Provider business mailing address

2310 W INTERSTATE 20 STE: 204
ARLINGTON TX
76017-1677
US

V. Phone/Fax

Practice location:
  • Phone: 817-466-7276
  • Fax: 817-466-7286
Mailing address:
  • Phone: 817-466-7276
  • Fax: 817-466-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1116390
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: