Provider Demographics
NPI:1255812327
Name:SMITH, CRISTINA (PTA)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 RIVER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2605
Mailing Address - Country:US
Mailing Address - Phone:505-850-7457
Mailing Address - Fax:
Practice Address - Street 1:2700 MEMORIAL PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-8481
Practice Address - Country:US
Practice Address - Phone:325-643-9801
Practice Address - Fax:325-646-9359
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085679225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2085679OtherPHYSICAL THERAPY ASSISTANCE