Provider Demographics
NPI:1245549674
Name:PHIPPS, KRISTA MICHELLE (PT)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:MICHELLE
Last Name:PHIPPS
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 1:1222 HARTON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2712
Mailing Address - Country:US
Mailing Address - Phone:479-531-0750
Mailing Address - Fax:
Practice Address - Street 1:2113 WATTS RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2856
Practice Address - Country:US
Practice Address - Phone:501-778-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist