Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1209096 | TX |
NPI | 1285049544 |
---|---|
Provider Name | Kristina R Stanich |
First Address | Denton, TX 76208-5528 |
Second Address | Argyle, TX 76226-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 25/06/2014 |