Healthcare Provider Details

I. General information

NPI: 1366924847
Provider Name (Legal Business Name): KRISTI L HALEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8836 MARS DR
HEWITT TX
76643-3195
US

IV. Provider business mailing address

3801 COBBS DR
WACO TX
76708-3011
US

V. Phone/Fax

Practice location:
  • Phone: 254-420-5500
  • Fax:
Mailing address:
  • Phone: 512-963-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2130869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: