Provider Demographics
NPI:1568868958
Name:CHAVEZ, KRISTY (ATC, LAT, LMT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:ATC, LAT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 AVENIDA DE LAS AMERICAS
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77010-6035
Mailing Address - Country:US
Mailing Address - Phone:713-876-2278
Mailing Address - Fax:
Practice Address - Street 1:1001 AVENIDA DE LAS AMERICAS
Practice Address - Street 2:STE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77010-6035
Practice Address - Country:US
Practice Address - Phone:713-876-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT101355225700000X
TXAT57312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist