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NPI Code Detail

MEDICARE: CRYSTAL S WOOD PTA

MEDICARE: CRYSTAL S WOOD PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant3866TN

General Provider Information

NPI Number : 1790851491
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL S WOOD PTA
Provider Business Mailing Address
First Line : 105 HEDGEWOOD DR
Second Line :
City : LEXINGTON
State : TN
Zip : 38351-1332
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 VOLUNTEER DR
Second Line :
City : PARIS
State : TN
Zip : 38242-5472
Country : US
Telephone Number : 731-642-2535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2006
Last Update Date : 07/08/2007

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Directions to “ CRYSTAL S WOOD PTA” Practice Location

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