Provider Demographics
NPI:1295444131
Name:KREBS, CHRISTINA DESTEFANO (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DESTEFANO
Last Name:KREBS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:DESTEFANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25118 KNOB PINES CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4247
Mailing Address - Country:US
Mailing Address - Phone:713-899-6024
Mailing Address - Fax:
Practice Address - Street 1:10333 KUYKENDAHL RD STE C
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2878
Practice Address - Country:US
Practice Address - Phone:832-813-7023
Practice Address - Fax:832-813-7099
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2113090225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2113090OtherPHYSICAL THERAPY LICENSE