=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508298480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTAN MICHELE NOVOSAD DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2013
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 FM3036
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-728-8668
-----------------------------------------------------
Fax | 800-920-4110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5833 W I-20
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76017-1057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-516-1115
-----------------------------------------------------
Fax | 817-516-1104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 3113547
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------