Provider Demographics
NPI:1104845221
Name:DUCKWORTH, KRISTIN M (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 ELDORADO PKWY # 102-20PR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:972-347-1111
Mailing Address - Fax:972-347-1116
Practice Address - Street 1:821 N COLEMAN ST STE 160
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2306
Practice Address - Country:US
Practice Address - Phone:972-347-1111
Practice Address - Fax:972-347-1116
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1168581OtherPHYSICAL THERAPY
TX8T6633OtherBCBS
TX8T6633OtherBCBS