Provider Demographics
NPI:1548620339
Name:GARNER, KRISTIN ELAINE (PTA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELAINE
Last Name:GARNER
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 1:2911 RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3443
Mailing Address - Country:US
Mailing Address - Phone:817-723-1085
Mailing Address - Fax:
Practice Address - Street 1:1103 W ARKANSAS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7601
Practice Address - Country:US
Practice Address - Phone:692-622-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2093349261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy