Provider Demographics
NPI:1588143549
Name:KRALL, SUSAN KAY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:KRALL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 ATLANTA DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5681
Mailing Address - Country:US
Mailing Address - Phone:972-955-1390
Mailing Address - Fax:
Practice Address - Street 1:6801 ATLANTA DR
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5681
Practice Address - Country:US
Practice Address - Phone:972-955-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist