MEDICARE: SUSAN KAY KRALL PHYSICAL THERAPIST

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
1	225100000X	Physical Therapist	1034494	TX

General Provider Information

NPI Number	:	1588143549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KAY KRALL PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	6801 ATLANTA DR
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-5681
Country	:	US
Telephone Number	:	972-955-1390
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 ATLANTA DR
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-5681
Country	:	US
Telephone Number	:	972-955-1390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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