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NPI Code Detail

MEDICARE: CRYSTAL MCKISSICK P.T.A.

MEDICARE: CRYSTAL MCKISSICK P.T.A.
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
1171W00000XContractorTE001843LPA

General Provider Information

NPI Number : 1821218710
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL MCKISSICK P.T.A.
Provider Business Mailing Address
First Line : 14 LINCOLN AVE
Second Line :
City : YEADON
State : PA
Zip : 19050
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14 LINCOLN AVE
Second Line :
City : YEADON
State : PA
Zip : 19050-2822
Country : US
Telephone Number : 610-626-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 02/07/2013

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