Provider Demographics
NPI:1205090388
Name:ARCHIBALD, KRISTI KRUGER (PT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:KRUGER
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ANN
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4621 W PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2318
Mailing Address - Country:US
Mailing Address - Phone:972-985-1776
Mailing Address - Fax:972-985-6088
Practice Address - Street 1:4621 W PARK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2318
Practice Address - Country:US
Practice Address - Phone:972-985-1776
Practice Address - Fax:972-985-6088
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist