Provider Demographics
NPI:1942539911
Name:PLUNK, KRISTI MICHELLE (PT, DPT, WCS, CLT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MICHELLE
Last Name:PLUNK
Suffix:
Gender:F
Credentials:PT, DPT, WCS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4244
Mailing Address - Country:US
Mailing Address - Phone:817-786-8058
Mailing Address - Fax:817-786-8057
Practice Address - Street 1:1248 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4244
Practice Address - Country:US
Practice Address - Phone:817-786-8058
Practice Address - Fax:817-786-8057
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031945-1225100000X
TX1169113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400030904Medicare PIN