Provider Demographics
NPI:1629479142
Name:DAVENPORT, KRISTEN (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:KLITTICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8607
Mailing Address - Country:US
Mailing Address - Phone:972-724-2400
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:413 W BETHEL RD STE 400
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4477
Practice Address - Country:US
Practice Address - Phone:972-304-9100
Practice Address - Fax:972-304-9048
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41640225100000X
TX1276281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist