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General NPI Number Information
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NPI Number | 1861052870
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Entity Type | Individual
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Provider Name | CHRISTINA CRAYTON LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 800 5TH AVE STE 500
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City | FORT WORTH
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State | TX
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Zip | 76104-7304
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Country | US
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Telephone | 817-878-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 CHICORA CT APT 321
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City | FORT WORTH
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State | TX
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Zip | 76116-5814
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | TX
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