Provider Demographics
NPI:1225460751
Name:WOOLLEY, KRISTAH LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTAH
Middle Name:LYNN
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTAH
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3000 RICHMOND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 TIMMONS LN STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5925
Practice Address - Country:US
Practice Address - Phone:713-621-2486
Practice Address - Fax:713-621-2491
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist