Provider Demographics
NPI:1568180354
Name:CRISTEE, ALEX KYLE (PTA)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:KYLE
Last Name:CRISTEE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-2573
Mailing Address - Country:US
Mailing Address - Phone:870-919-6592
Mailing Address - Fax:
Practice Address - Street 1:911 SANDRA LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-2573
Practice Address - Country:US
Practice Address - Phone:870-919-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2745225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant