Provider Demographics
NPI:1659982858
Name:KRISTOF, ERIC ANDREW
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANDREW
Last Name:KRISTOF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560817
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-0817
Mailing Address - Country:US
Mailing Address - Phone:972-998-7331
Mailing Address - Fax:
Practice Address - Street 1:9200 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6555
Practice Address - Country:US
Practice Address - Phone:972-712-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765933163W00000X
TXMI2983225700000X
TXMT037254225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT03754OtherMASSAGE THERAPIST, TEXAS
TXMI2983OtherMASSAGE THERAPY INSTRUCTOR, TEXAS
TX765933OtherREGISTERED NURSE , TEXAS