MEDICARE: MRS. KRISTINA LYN MCDONALD MPT

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	1111151	TX

General Provider Information

NPI Number	:	1851590095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA LYN MCDONALD MPT

Provider Business Mailing Address
First Line	:	300 E HOUSTON ST
Second Line	:	SUITE A
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4554
Country	:	US
Telephone Number	:	281-592-2884
Fax Number	:	281-592-3269

Provider Business Practice Location Address
First Line	:	300 E HOUSTON ST
Second Line	:	SUITE A
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4554
Country	:	US
Telephone Number	:	281-592-2884
Fax Number	:	281-592-3269

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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