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NPI Code Detail

MEDICARE: KELLI CRISP DPT

MEDICARE: KELLI CRISP DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1360413TX

General Provider Information

NPI Number : 1194458141
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI CRISP DPT
Provider Business Mailing Address
First Line : 160 W MAGNOLIA AVE STE 2
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-7613
Country : US
Telephone Number : 817-335-7946
Fax Number : 817-335-7947
Provider Business Practice Location Address
First Line : 160 W MAGNOLIA AVE STE 2
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-7613
Country : US
Telephone Number : 817-335-7946
Fax Number : 817-335-7947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2022
Last Update Date : 01/31/2023

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Directions to “ KELLI CRISP DPT” Practice Location

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