Provider Demographics
NPI:1952696890
Name:GARRETT, KRISTA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:GARRETT
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 1:3214 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3337
Mailing Address - Country:US
Mailing Address - Phone:850-819-0709
Mailing Address - Fax:
Practice Address - Street 1:6012 MAGNOLIA BEACH RD
Practice Address - Street 2:VILLA 602
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7065
Practice Address - Country:US
Practice Address - Phone:850-230-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19860225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant