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General NPI Number Information
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NPI Number | 1063444743
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Entity Type | Individual
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Provider Name | KERI LYN GUSTAVSEN P.T.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 100 COUNTRY CLUB RD STE 120
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City | ARGYLE
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State | TX
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Zip | 76226-2358
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Country | US
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Telephone | 940-464-0055
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Fax | 940-464-7755
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Provider Business Mailing Address
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Address Line | PO BOX 372
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City | ARGYLE
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State | TX
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Zip | 76226-0372
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Country | US
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Telephone | 940-464-0055
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Fax | 940-464-7755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1161526
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1161526
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License Number State | TX
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