Provider Demographics
NPI:1144836875
Name:PEREZ, KRISTEN MARIE (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:TOWNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5040 ADDISON CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6049
Mailing Address - Country:US
Mailing Address - Phone:214-983-0303
Mailing Address - Fax:
Practice Address - Street 1:401 W SLAUGHTER LN STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1774
Practice Address - Country:US
Practice Address - Phone:512-277-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1335688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist