Healthcare Provider Details

I. General information

NPI: 1548740285
Provider Name (Legal Business Name): KRISTIN ANTHONY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN MCREYNOLDS PT, DPT

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17692 1ST AVE S
BURIEN WA
98148-1729
US

IV. Provider business mailing address

8515 FANNIN ST STE 140
HOUSTON TX
77054-4820
US

V. Phone/Fax

Practice location:
  • Phone: 62-410-4772
  • Fax: 206-241-0538
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1306278
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberCP019042T
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: