Provider Demographics
NPI:1821258690
Name:COLLINS, KRISTY PETERS (PT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:PETERS
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3421 W DAVIS ST
Mailing Address - Street 2:STE 210
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1890
Mailing Address - Country:US
Mailing Address - Phone:979-822-6467
Mailing Address - Fax:979-821-9448
Practice Address - Street 1:1504 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1015
Practice Address - Country:US
Practice Address - Phone:979-822-6467
Practice Address - Fax:979-821-9448
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139335225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1139335OtherSTATE LICENSE