Provider Demographics
NPI:1790291854
Name:BENNETT TONEY, KRISTEN KATE (MT042589)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KATE
Last Name:BENNETT TONEY
Suffix:
Gender:F
Credentials:MT042589
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W BEDFORD EULESS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4042
Mailing Address - Country:US
Mailing Address - Phone:817-412-4429
Mailing Address - Fax:
Practice Address - Street 1:204 W BEDFORD EULESS RD STE 100
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4042
Practice Address - Country:US
Practice Address - Phone:817-412-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT042589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist