Provider Demographics
NPI:1780338772
Name:FAULKNER, KRISTA M (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10152 WANDERING WAY ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3012
Mailing Address - Country:US
Mailing Address - Phone:817-455-5455
Mailing Address - Fax:
Practice Address - Street 1:5500 OVERTON RIDGE BLVD STE 228
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3281
Practice Address - Country:US
Practice Address - Phone:817-259-1255
Practice Address - Fax:817-764-9008
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist