Provider Demographics
NPI:1386828200
Name:MCCONNELL, KRISTEN J (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:J
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6462 COUNTY ROAD 4095
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-7210
Mailing Address - Country:US
Mailing Address - Phone:972-486-3115
Mailing Address - Fax:
Practice Address - Street 1:1121 FLOWER MOUND RD
Practice Address - Street 2:SUITE 540
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3504
Practice Address - Country:US
Practice Address - Phone:972-355-5200
Practice Address - Fax:972-355-5800
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist