Provider Demographics
NPI:1659337004
Name:BROOKS, KRISTEN LEIGH (MS, ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEIGH
Other - Last Name:MONAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC, LAT, CSCS
Mailing Address - Street 1:6141 AVERY DR
Mailing Address - Street 2:APT #7310
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-5316
Mailing Address - Country:US
Mailing Address - Phone:817-343-1531
Mailing Address - Fax:
Practice Address - Street 1:2900 STADIUM DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76129-0001
Practice Address - Country:US
Practice Address - Phone:817-257-5359
Practice Address - Fax:817-257-7323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer