Provider Demographics
NPI:1093993289
Name:CLARKE, CRISTAL ROBERTA (DPT)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:ROBERTA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GREENS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2101
Mailing Address - Country:US
Mailing Address - Phone:281-873-0111
Mailing Address - Fax:
Practice Address - Street 1:401 GREENS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2101
Practice Address - Country:US
Practice Address - Phone:281-873-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist