Provider Demographics
NPI:1063632404
Name:VUELVAS, KRISTIEN BERNADETT (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIEN
Middle Name:BERNADETT
Last Name:VUELVAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KRISTIEN
Other - Middle Name:BERNADETT
Other - Last Name:HEREDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT A
Mailing Address - Street 1:2936 W ROYAL LN
Mailing Address - Street 2:# 1138
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3315
Mailing Address - Country:US
Mailing Address - Phone:972-375-1538
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PKWY
Practice Address - Street 2:SUITE 225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2576
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:972-812-3283
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2051202225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant