Provider Demographics
NPI:1609844455
Name:THIBODEAUX, CRISTINA MARIE (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:MARIE
Last Name:THIBODEAUX
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
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Mailing Address - Street 1:3423 PARK ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-630-1225
Mailing Address - Fax:
Practice Address - Street 1:23780 US 59 NORTH
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-358-1838
Practice Address - Fax:281-358-1812
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist