Provider Demographics
NPI:1295068906
Name:DURBIN, RISTY (PT)
Entity type:Individual
Prefix:
First Name:RISTY
Middle Name:
Last Name:DURBIN
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 1:7730 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-6239
Mailing Address - Country:US
Mailing Address - Phone:832-921-7047
Mailing Address - Fax:
Practice Address - Street 1:7730 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-6239
Practice Address - Country:US
Practice Address - Phone:832-921-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-13
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1155398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1155398OtherEXECUTIVE COUNCIL OF PHYSICAL THERAPY EXAMINERS