Provider Demographics
NPI:1740315092
Name:BRANCH, KRISTA MICHELLE MORGAN (PT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MICHELLE MORGAN
Last Name:BRANCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7215 W BRIDLE TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-8025
Mailing Address - Country:US
Mailing Address - Phone:928-226-1789
Mailing Address - Fax:928-779-0557
Practice Address - Street 1:15 E CHERRY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4699
Practice Address - Country:US
Practice Address - Phone:928-779-0446
Practice Address - Fax:928-779-0557
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-8335225100000X
AZ41152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ474924OtherAHCCCS PROVIDER ID