Provider Demographics
NPI:1861052870
Name:CRAYTON, CHRISTINA (LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:CRAYTON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:3650 CHICORA CT APT 321
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 5TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7304
Practice Address - Country:US
Practice Address - Phone:817-878-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer