Provider Demographics
NPI:1578390142
Name:BELTRAN, KRISTINA MARIA (PTA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIA
Last Name:BELTRAN
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 1:2841 BRIDAL WREATH LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-3207
Mailing Address - Country:US
Mailing Address - Phone:972-955-4610
Mailing Address - Fax:
Practice Address - Street 1:12228 N CENTRAL EXPY STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3824
Practice Address - Country:US
Practice Address - Phone:469-706-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2153588225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant