Provider Demographics
NPI:1881832186
Name:MARTIN, KRISTINA LYNCH (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNCH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 BRYANT IRVIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4230
Mailing Address - Country:US
Mailing Address - Phone:817-294-4646
Mailing Address - Fax:
Practice Address - Street 1:5950 BRYANT IRVIN RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4230
Practice Address - Country:US
Practice Address - Phone:817-294-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10485512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic