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:
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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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-8335225100000X
AZ41152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ474924OtherAHCCCS PROVIDER ID