Provider Demographics
NPI:1063409100
Name:WALTON, KRISTEN B (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:B
Last Name:WALTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BREHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:910 HILLS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5232
Mailing Address - Country:US
Mailing Address - Phone:972-486-3115
Mailing Address - Fax:972-486-3115
Practice Address - Street 1:11661 PRESTON RD
Practice Address - Street 2:SUITE 173
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2745
Practice Address - Country:US
Practice Address - Phone:214-265-7200
Practice Address - Fax:214-265-7521
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0432Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER