Healthcare Provider Details

I. General information

NPI: 1881520302
Provider Name (Legal Business Name): CRYSTALLIZED 2.0 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 RATHLIN LN
BEAR DE
19701-1987
US

IV. Provider business mailing address

PO BOX 349
BEAR DE
19701-0349
US

V. Phone/Fax

Practice location:
  • Phone: 646-477-9493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL THOMAS-MCGEE
Title or Position: MANAGING MEMBER
Credential: PT, DPT, MBA
Phone: 631-766-4236